Individual
ELLEN M MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2304 W MERCURY BLVD, HAMPTON, VA 23666-3115
(757) 595-9880
(757) 595-0362
Mailing address
5000 COX RD STE 303, GLEN ALLEN, VA 23060-9263
(804) 968-5700
(757) 232-8866
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110840718
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
970000324
—
VA
Enumeration date
02/21/2006
Last updated
02/23/2022
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