Organization
MONTGOMERY EKG LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW J CONNOLLY M.D. (PRESIDENT)
(301) 774-8882
Entity
Organization
Contact information
Practice address
18101 PRINCE PHILIP DR, OLNEY, MD 20832-1514
(301) 774-8882
Mailing address
18101 PRINCE PHILIP DR, OLNEY, MD 20832-1514
(301) 774-8882
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DA2369
RAILROAD MEDICARE
MD
01
—
H954
GHI
DC
01
—
KFA8MO
BLUE SHIELD
MD
Enumeration date
01/15/2007
Last updated
10/25/2007
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