Provider Demographics
NPI:1164445326
Name:CASSIDY, MARGARET L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:L
Last Name:CASSIDY
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 1:304 N LOCKE AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5855
Mailing Address - Country:US
Mailing Address - Phone:505-324-1100
Mailing Address - Fax:505-324-1117
Practice Address - Street 1:304 N LOCKE AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5855
Practice Address - Country:US
Practice Address - Phone:505-324-1100
Practice Address - Fax:505-324-1117
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-202207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201011965OtherPRESBYTERIAN ID
NMNM002537OtherBC/BS PROVIDER ID
NM80146308OtherRAILROAD MEDICARE NUMBER
NMNMAAA1342OtherMEDICARE PROVIDER NUMBER
NMR7312Medicaid
NM80146308OtherRAILROAD MEDICARE NUMBER