Provider Demographics
NPI:1952373052
Name:MONTGOMERY, KAREN ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 HOSPITAL DR STE 350
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2867
Practice Address - Country:US
Practice Address - Phone:740-592-7040
Practice Address - Fax:740-592-7041
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.004115208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0946034Medicaid
OH0946034Medicaid
OHRE0788981Medicare ID - Type Unspecified