Main Line Psychiatric Assoc. LTD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

0242722 Issued in PA

Legal business name

MAIN LINE PSYCHIATRIC ASSOC. LTD

Practice address

100 Lancaster Avenue
441 Lankenau Medical Building
Wynnewood, PA 19096

Phone

(610) 457-3744

Fax

(610) 667-9123

NPI assigned

Aug 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dewitt H Montgomery Jr., MD

Title

President

Phone

(610) 457-3744

Specialties & licenses 1

Addresses

Other names 1

• DEWITT H MONTGOMERY JR MD Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219017600000",
    "number": "1487768487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3012",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "19804",
            "telephone_number": "800-456-4629",
            "fax_number": "302-224-2848"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 LANCASTER AVENUE",
            "address_2": "441 LANKENAU MEDICAL BUILDING",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "19096",
            "telephone_number": "610-457-3744",
            "fax_number": "610-667-9123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN LINE PSYCHIATRIC ASSOC. LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2008-08-18",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "DEWITT",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-457-3744",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "PA",
            "license": "0242722",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEWITT H MONTGOMERY JR MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Psychiatry Physician in Wynnewood, PA
• Providers in Wynnewood, PA by specialty
• Psychiatry Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.