Provider Demographics
NPI:1528120524
Name:SELIGMAN, MARGOT SUE (OD)
Entity type:Individual
Prefix:DR
First Name:MARGOT
Middle Name:SUE
Last Name:SELIGMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422-424 HANOVER STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113
Mailing Address - Country:US
Mailing Address - Phone:617-864-7005
Mailing Address - Fax:617-864-7005
Practice Address - Street 1:1 PORTER SQ
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1431
Practice Address - Country:US
Practice Address - Phone:617-864-7005
Practice Address - Fax:617-864-3250
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3216152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353116Medicaid
MA15509OtherHARVARD PILGRIM
MAW15684OtherBLUE CROSS BLUE SHIELD
MA703139OtherTUFTS HEALTH PLAN
MA703139OtherTUFTS HEALTH PLAN
MA403658Medicare ID - Type Unspecified