Basic Information
| Provider Information | |||||||||
| NPI: | 1659927234 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | RAGEN | ||||||||
| FirstName: | MARGARET | ||||||||
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| Credential: | LM, CM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 237 JEFFERSON AVE APT 6 | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112161785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033136132 | ||||||||
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| Practice Location | |||||||||
| Address1: | 595 HAMPTON RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHAMPTON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 119683004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6312830918 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2019 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 001927 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | NY | MEDICAID |