Provider Demographics
NPI:1386741825
Name:EASTHAM, MARGARET ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:ELLEN
Last Name:EASTHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:727-266-4943
Practice Address - Street 1:1030 CHALET SUZANNE RD
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33859-7760
Practice Address - Country:US
Practice Address - Phone:863-679-1818
Practice Address - Fax:863-679-1097
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252038900Medicaid
FL38027YMedicare PIN
FL38027XMedicare PIN
FLG60340Medicare UPIN