1659506640 NPI number — DR. REBEKAH MONTGOMERY PH.D

Table of content: DR. REBEKAH MONTGOMERY PH.D (NPI 1659506640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659506640 NPI number — DR. REBEKAH MONTGOMERY PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
REBEKAH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MAJORS
Provider Other First Name:
REBEKAH
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659506640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 POST OFFICE SQ
Provider Second Line Business Mailing Address:
SUITE 800 SOUTH
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02109-4603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-692-2938
Provider Business Mailing Address Fax Number:
617-692-2901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 POST OFFICE SQ
Provider Second Line Business Practice Location Address:
SUITE 800 SOUTH
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02109-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-692-2938
Provider Business Practice Location Address Fax Number:
617-692-2901
Provider Enumeration Date:
05/20/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: PS01192 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X , with the licence number: 9647 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)