Provider Demographics
NPI:1508848409
Name:UPHOFF, MARGUERITE H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARGUERITE
Middle Name:H
Last Name:UPHOFF
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 1:10 GRAHAM RD W
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1055
Mailing Address - Country:US
Mailing Address - Phone:607-257-2188
Mailing Address - Fax:607-266-7341
Practice Address - Street 1:10 GRAHAM RD W
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1055
Practice Address - Country:US
Practice Address - Phone:607-257-2188
Practice Address - Fax:607-266-7341
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106924208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
V018315OtherTRICARE
NY00467661Medicaid
161010811OtherRMSCO
NY6492OtherTOTALCARE/MANAGED MA
4217140OtherAETNA MANAGED CHOICE
000910785001OtherHEALTHNOW
08839OtherBLUE SHIELD/HMO/EXCELLUS