Douglas, Montgomery Bernard

Douglas, Montgomery Bernard is an individual health care provider with primary practice located at Uconn Medical Group 263 Farmington Ave, Farmington CT 06030-0001. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Geriatric Medicine, Allopathic & Osteopathic Physicians / Family Medicine. Allopathic & Osteopathic Physicians / Family Medicine is his primary health care specialty. Douglas, Montgomery Bernard can be contacted via phone (860) 679-4477.

Contact Information

Primary practice address
Uconn Medical Group 263 Farmington Ave Farmington CT 06030-0001
Phone: (860) 679-4477
Fax: (860) 679-4474
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X 171089 New York
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 054868 Connecticut
Allopathic & Osteopathic Physicians / Geriatric Medicine 207QG0300X 054868 Connecticut

Profile Details

NPI number 1114120839
LBN Legal business name Douglas, Montgomery Bernard
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 8th, 2007
Last updated Jul 15th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1114120839 NPPES
New York MEDICAID 01141015

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