1295760841 NPI number — AMY JILL MARGOLIS DO

Table of content: AMY JILL MARGOLIS DO (NPI 1295760841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295760841 NPI number — AMY JILL MARGOLIS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARGOLIS
Provider First Name:
AMY
Provider Middle Name:
JILL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DELORIE
Provider Other First Name:
AMY
Provider Other Middle Name:
MARGOLIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295760841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PARKLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERRY
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03038-2746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-421-2220
Provider Business Mailing Address Fax Number:
603-421-2223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 PARKLAND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03038-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-421-2220
Provider Business Practice Location Address Fax Number:
603-421-2223
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  12420 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30223131 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2091640 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7769481 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04Y007571NH02 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 432640599 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7769481 . This is a "AETNA" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: P00190750 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04Y007571NH03 . This is a "BCBS OF NH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".




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