Provider Demographics
NPI:1275002495
Name:CORAM, MARGARET
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:CORAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:24572-2765
Mailing Address - Country:US
Mailing Address - Phone:434-221-3874
Mailing Address - Fax:
Practice Address - Street 1:232 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-2765
Practice Address - Country:US
Practice Address - Phone:434-221-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver