Provider Demographics
NPI:1801453006
Name:MONTGOMERY, BRITTANY COVIL (MD)
Entity type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:COVIL
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:BRITTANY
Other - Middle Name:MARIE
Other - Last Name:COVIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:727 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2209
Practice Address - Country:US
Practice Address - Phone:812-353-3450
Practice Address - Fax:812-353-3451
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01088880A2084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300080449Medicaid
IN090540865OtherMEDICARE PTAN