Most Relevant Information
Provider Data
| NPI Number: | 1003542663 |
| Provider Name: | CANADA MONTGOMERY |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/26/2022 |
| Last Updated: | 03/28/2023 |
Provider Practice Location
3400 SPRUCE ST
PHILADELPHIA
PA
191044238
Practice Location Phone/Fax
| Phone: | 4126070137 |
| Fax: |
Provider Mailing Location
3400 SPRUCE ST
PHILADELPHIA
PA
191044238
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |