Provider Demographics
NPI:1255315545
Name:KOEHM, MARGARET M (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:M
Last Name:KOEHM
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 1:57 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02554-2799
Mailing Address - Country:US
Mailing Address - Phone:508-325-9981
Mailing Address - Fax:508-325-8558
Practice Address - Street 1:57 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-2799
Practice Address - Country:US
Practice Address - Phone:508-325-9981
Practice Address - Fax:508-325-8558
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD213100207Q00000X
MA213100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9022680Medicaid
RI089022680Medicare PIN
RI9022680Medicaid
RIH04118Medicare UPIN