1902097652 NPI number — DR. MARGIE A AGAHAN O.D.

Table of content: DR. MARGIE A AGAHAN O.D. (NPI 1902097652)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902097652 NPI number — DR. MARGIE A AGAHAN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGAHAN
Provider First Name:
MARGIE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGAHAN
Provider Other First Name:
MARGIE
Provider Other Middle Name:
ASDILLA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1902097652
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 KALAMSA MACHECHE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEDEDO
Provider Business Mailing Address State Name:
GU
Provider Business Mailing Address Postal Code:
96921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
671-649-0600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 SOUTH MARINE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 131, GITC BLDG
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GU
Provider Business Practice Location Address Postal Code:
96931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
671-649-0600
Provider Business Practice Location Address Fax Number:
671-649-0666
Provider Enumeration Date:
08/07/2007

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: 152W00000X , with the licence number:  GUAM LIC. 016 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 168 , issued by the state of ( GU ) . This identifiers is of the category "MEDICAID".




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