1770878936 NPI number — REBECCA LYNN MARGERUM MACLEOD M.S.

Table of content: REBECCA LYNN MARGERUM MACLEOD M.S. (NPI 1770878936)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770878936 NPI number — REBECCA LYNN MARGERUM MACLEOD M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARGERUM MACLEOD
Provider First Name:
REBECCA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARGERUM
Provider Other First Name:
REBECCA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770878936
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
157 E NEW ENGLAND AVE
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
WINTER PARK
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32789-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-644-4231
Provider Business Mailing Address Fax Number:
407-628-8996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
157 E NEW ENGLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
WINTER PARK
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32789-4346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-644-4231
Provider Business Practice Location Address Fax Number:
407-628-8996
Provider Enumeration Date:
06/16/2011

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: 101YM0800X , with the licence number:  MH10429 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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