Provider Demographics
NPI:1003972944
Name:MAYERS, MARGUERITE M (MD)
Entity Type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:M
Last Name:MAYERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 KOSSUTH AVE
Mailing Address - Street 2:MMC
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467
Mailing Address - Country:US
Mailing Address - Phone:718-920-5871
Mailing Address - Fax:
Practice Address - Street 1:MMC - FAMILY CARE CENTER
Practice Address - Street 2:3444 KOSSUTH AVENUE, 2ND FL.
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-5271
Practice Address - Fax:718-652-5707
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114891208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00928996Medicaid
B07934Medicare UPIN