Provider Demographics
NPI:1477546851
Name:POULOS, MARGARET K (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:K
Last Name:POULOS
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 1:324 E PAR ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4004
Mailing Address - Country:US
Mailing Address - Phone:407-843-2020
Mailing Address - Fax:407-649-9299
Practice Address - Street 1:324 E PAR ST STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4004
Practice Address - Country:US
Practice Address - Phone:407-843-2020
Practice Address - Fax:407-649-9299
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070309207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250088400Medicaid
FL250088400Medicaid
FLF80793Medicare UPIN