1700849205 NPI number — MS. MARGARET MARY HOULEHAN PA-C

Table of content: MS. MARGARET MARY HOULEHAN PA-C (NPI 1700849205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700849205 NPI number — MS. MARGARET MARY HOULEHAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOULEHAN
Provider First Name:
MARGARET
Provider Middle Name:
MARY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700849205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 BALLARD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27712-2184
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-479-9305
Provider Business Mailing Address Fax Number:
919-286-6896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
46 FAIRVIEW AVE STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKOWHEGAN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04976-1481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-474-0905
Provider Business Practice Location Address Fax Number:
207-474-6930
Provider Enumeration Date:
04/07/2006

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: 363AM0700X , with the licence number:  101809 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA2664 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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