Provider Demographics
NPI:1972555332
Name:MARCRANDER, MARGARET SOPUCH (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:SOPUCH
Last Name:MARCRANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD STE 1015B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8203
Mailing Address - Country:US
Mailing Address - Phone:314-251-8965
Mailing Address - Fax:314-251-8966
Practice Address - Street 1:621 S NEW BALLAS RD STE 1015B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8203
Practice Address - Country:US
Practice Address - Phone:314-251-8965
Practice Address - Fax:314-251-8966
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO112886207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO10961846OtherCAQH
MOH706345Medicare UPIN