Provider Demographics
NPI:1306941422
Name:SPEAS, MARGARET SEAWELL (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:SEAWELL
Last Name:SPEAS
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:799 N HIGHLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27102-0686
Mailing Address - Country:US
Mailing Address - Phone:336-703-3319
Mailing Address - Fax:336-727-8135
Practice Address - Street 1:799 N HIGHLAND AVENUE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27102-0686
Practice Address - Country:US
Practice Address - Phone:336-703-3319
Practice Address - Fax:336-727-8135
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC102656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP09256Medicare UPIN