1639193907 NPI number — THOMAS W MONTAG MD PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639193907 NPI number — THOMAS W MONTAG MD PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS W MONTAG MD PLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639193907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 WIMBLEDON SQ
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
CHESAPEAKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23320-4945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-436-9898
Provider Business Mailing Address Fax Number:
757-436-5455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 WIMBLEDON SQ
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
CHESAPEAKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23320-4945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-436-9898
Provider Business Practice Location Address Fax Number:
757-436-5455
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONTAG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
W
Authorized Official Title or Position:
MANAGING MEMBER GYN ONCOLOGIST
Authorized Official Telephone Number:
757-436-9898

Provider Taxonomy Codes

  • Taxonomy code: 207VX0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0101059160 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 621780-0 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: C09977 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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