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Individual

THOMAS R MONTGOMERY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-2840
(757) 668-2845
Mailing address
PO BOX 79137, BALTIMORE, MD 21279-0137
(757) 668-7200
(757) 668-9691

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0101035588
VA
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
0101035588
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0018739090001
PA
05
006722440
VA
05
130371600
MD
05
890534Y
NC
Enumeration date
05/24/2006
Last updated
12/17/2009
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