Provider Demographics
NPI:1801657945
Name:MONTGOMERY, MARSHA JAN (CPD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:JAN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:CPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3321
Mailing Address - Country:US
Mailing Address - Phone:508-259-1523
Mailing Address - Fax:
Practice Address - Street 1:21 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3321
Practice Address - Country:US
Practice Address - Phone:508-259-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14733374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty