Provider Demographics
NPI:1114021524
Name:AVAGLIANO, MARGARET C (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:C
Last Name:AVAGLIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PEGGY
Other - Middle Name:C
Other - Last Name:AVAGLIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:72 W JIMMIE LEEDS RD
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-9406
Mailing Address - Country:US
Mailing Address - Phone:609-677-9729
Mailing Address - Fax:609-652-7153
Practice Address - Street 1:30 E MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2451
Practice Address - Country:US
Practice Address - Phone:609-677-9729
Practice Address - Fax:609-652-6270
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA071013002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00847750OtherRAILROAD MEDICARE
NJP00793697OtherRAILROAD MEDICARE
NJ300115512OtherRAILROAD MEDICARE
NJ8289107Medicaid
NJ300115512OtherRAILROAD MEDICARE
NJP00793697OtherRAILROAD MEDICARE
H03743Medicare UPIN
NJ8289107Medicaid