Provider Demographics
NPI:1871530618
Name:MONTGOMERY COUNTY MEDICAL ASSOCIATES, LTD.
Entity type:Organization
Organization Name:MONTGOMERY COUNTY MEDICAL ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCELWAIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:215-947-7924
Mailing Address - Street 1:1650 HUNTINGDON PIKE
Mailing Address - Street 2:SUITE 156
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8004
Mailing Address - Country:US
Mailing Address - Phone:215-947-7924
Mailing Address - Fax:215-947-0187
Practice Address - Street 1:1650 HUNTINGDON PIKE
Practice Address - Street 2:SUITE 156
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8004
Practice Address - Country:US
Practice Address - Phone:215-947-7924
Practice Address - Fax:215-947-0187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care FacilityGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACF3420OtherRAILROAD MEDICARE
PA1047576 01Medicaid
PA1047576 01Medicaid
PACF3420OtherRAILROAD MEDICARE
PA=========OtherTAX I.D.