Provider Demographics
NPI:1982795787
Name:DIVISH, MARGARET MARY (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:DIVISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1408 EAST BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-5875
Mailing Address - Country:US
Mailing Address - Phone:704-355-9355
Mailing Address - Fax:704-444-2790
Practice Address - Street 1:1408 EAST BLVD STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-5875
Practice Address - Country:US
Practice Address - Phone:704-355-9355
Practice Address - Fax:704-444-2790
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9600901207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2064536Medicare PIN
NCF88400Medicare UPIN