Provider Demographics
NPI:1275692626
Name:MORESHEAD, MARGARET L (PA C)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:L
Last Name:MORESHEAD
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2041 JENSEN DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112
Mailing Address - Country:US
Mailing Address - Phone:505-292-5327
Mailing Address - Fax:505-247-8509
Practice Address - Street 1:500 WALTER NE
Practice Address - Street 2:SUITE 204
Practice Address - City:ALBUQERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-842-5518
Practice Address - Fax:505-247-8509
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMPA20030024363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q05732Medicare UPIN