Provider Demographics
NPI:1124298831
Name:THORHALLSDOTTIR, MARGRET (MD)
Entity type:Individual
Prefix:
First Name:MARGRET
Middle Name:
Last Name:THORHALLSDOTTIR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6573 A1A S
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-7504
Mailing Address - Country:US
Mailing Address - Phone:904-342-7363
Mailing Address - Fax:
Practice Address - Street 1:6573 A1A S
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-7504
Practice Address - Country:US
Practice Address - Phone:904-342-7363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109067207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003762800Medicaid
FLFD323YMedicare PIN