Basic Information
| Provider Information | |||||||||
| NPI: | 1295760841 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARGOLIS | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | JILL | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DELORIE | ||||||||
| OtherFirstName: | AMY | ||||||||
| OtherMiddleName: | MARGOLIS | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | DO | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1 PARKLAND DR | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030382746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034212220 | ||||||||
| FaxNumber: | 6034212223 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 PARKLAND DR | ||||||||
| Address2: | |||||||||
| City: | DERRY | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030382746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6034212220 | ||||||||
| FaxNumber: | 6034212223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 05/04/2018 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 12420 | NH | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30223131 | 05 | NH | MEDICAID | 2091640 | 05 | MA | MEDICAID | 7769481 | 01 | AETNA | OTHER | 04Y007571NH02 | 01 | NH | ANTHEM | OTHER | 432640599 | 05 | ME | MEDICAID | 7769481 | 01 | NH | AETNA | OTHER | P00190750 | 01 | RAILROAD MEDICARE | OTHER | 04Y007571NH03 | 01 | NH | BCBS OF NH | OTHER |