Provider Demographics
NPI:1427033349
Name:MARGIE, WALTER EDWARD III (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:EDWARD
Last Name:MARGIE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1863
Mailing Address - Country:US
Mailing Address - Phone:607-257-1126
Mailing Address - Fax:607-257-0955
Practice Address - Street 1:16 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1863
Practice Address - Country:US
Practice Address - Phone:607-257-1126
Practice Address - Fax:607-257-0955
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038632E207R00000X
NY187301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E52951Medicare UPIN