Provider Demographics
NPI:1386673291
Name:MACDOUGALL RIVERS, MARGARET L (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:MACDOUGALL RIVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:L
Other - Last Name:MACDOUGALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:90 PRESIDENTIAL PLZ
Mailing Address - Street 2:FIRM C
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2240
Mailing Address - Country:US
Mailing Address - Phone:315-464-3834
Mailing Address - Fax:315-464-3837
Practice Address - Street 1:90 PRESIDENTIAL PLZ
Practice Address - Street 2:FIRM C
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-2240
Practice Address - Country:US
Practice Address - Phone:315-464-3834
Practice Address - Fax:315-464-3837
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211881207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01868799Medicaid
NYP390005769Medicare PIN
NYBB1798Medicare PIN