Basic Information
| Provider Information | |||||||||
| NPI: | 1558748608 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JACKSON | ||||||||
| FirstName: | MARGARET | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 272 CONGRESS ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041013637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078742466 | ||||||||
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| Practice Location | |||||||||
| Address1: | 31 FRONT ST | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049016626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078731181 | ||||||||
| FaxNumber: | 2078731186 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2015 | ||||||||
| LastUpdateDate: | 02/24/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | FJ7754624 | ME | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.