Provider Demographics
NPI:1295864692
Name:DRS.MEDINA AND MARGALLO PEDIATRIC ASSOCIATES
Entity Type:Organization
Organization Name:DRS.MEDINA AND MARGALLO PEDIATRIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:COBIN
Authorized Official - Last Name:MARGALLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-228-1103
Mailing Address - Street 1:900 ROUTE 168
Mailing Address - Street 2:SUITE J2
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-3233
Mailing Address - Country:US
Mailing Address - Phone:856-228-1103
Mailing Address - Fax:856-374-1238
Practice Address - Street 1:900 ROUTE 168
Practice Address - Street 2:SUITE J2
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3233
Practice Address - Country:US
Practice Address - Phone:856-228-1103
Practice Address - Fax:856-374-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05665900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty