Provider Demographics
NPI:1447272844
Name:MONTGOMERY, LYNDA G (MD)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:G
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 PARK EAST DR STE 210
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4309
Mailing Address - Country:US
Mailing Address - Phone:216-245-5680
Mailing Address - Fax:
Practice Address - Street 1:3609 PARK EAST DR STE 210
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4309
Practice Address - Country:US
Practice Address - Phone:216-245-5680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.081131207Q00000X
OH35-081131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000312657OtherANTHEM
OHP00454363OtherRAILROAD MEDICARE
737690OtherBUCKEYE
000000224454OtherUNISON
OH7375280OtherAETNA
OH000000530394OtherANTHEM
OHP00333107OtherRAILROAD MEDICARE
OH2356114Medicaid
363854OtherWELLCARE
OHMO4087554Medicare PIN
OH7375280OtherAETNA
737690OtherBUCKEYE