Provider Demographics
NPI:1114103330
Name:THIRSTON, MARGARET ISABEL (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ISABEL
Last Name:THIRSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ISABEL
Other - Last Name:WILLIAMS-THIRSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1025 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4096
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:
Practice Address - Street 1:3301 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-3713
Practice Address - Country:US
Practice Address - Phone:217-277-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100633207L00000X, 207LP2900X
IL036114092207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2803569 00Medicaid
FL4258872OtherCIGNA
FL1114103OtherTRIWEST
FL12376OtherBCBSFL
FL12376OtherBCBSFL
FL12376OtherBCBSFL