Individual
MONTGOMERY BERNARD DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
UCONN MEDICAL GROUP, 263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-4477
(860) 679-4474
Mailing address
UCONN MEDICAL GROUP, 263 FARMINGTON AVE, FARMINGTON, CT 06030-0001
(860) 679-4477
(860) 679-4474
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
054868
CT
207QG0300X
Geriatric Medicine (Family Medicine) Physician
054868
CT
207QG0300X
Geriatric Medicine (Family Medicine) Physician
171089
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01141015
—
NY
Enumeration date
06/08/2007
Last updated
07/15/2016
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