Provider Demographics
NPI:1518909803
Name:MONTGOMERY RADIOLOGY ASSOCIATES INC
Entity type:Organization
Organization Name:MONTGOMERY RADIOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:LANGLINAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-953-5130
Mailing Address - Street 1:PO BOX 71162
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28272-1162
Mailing Address - Country:US
Mailing Address - Phone:540-953-5130
Mailing Address - Fax:678-459-0525
Practice Address - Street 1:3700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7017
Practice Address - Country:US
Practice Address - Phone:540-953-5130
Practice Address - Fax:678-459-0525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC00735Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER