Provider Demographics
NPI:1396839502
Name:BLACKWOOD, MARGARET MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MICHELLE
Last Name:BLACKWOOD
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 1:200 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-5817
Mailing Address - Country:US
Mailing Address - Phone:973-322-7020
Mailing Address - Fax:973-322-7039
Practice Address - Street 1:200 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-5817
Practice Address - Country:US
Practice Address - Phone:973-322-7020
Practice Address - Fax:973-322-7039
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07666200208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY193241OtherNYS LICENSE
NY02939751Medicaid
NY193241OtherNYS LICENSE
NY02939751Medicaid
NY25B8430741Medicare PIN