Provider Demographics
NPI:1629047501
Name:LAYCOCK, MARGARET ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:LAYCOCK
Suffix:
Gender:M
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:PO BOX 5545
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-5545
Mailing Address - Country:US
Mailing Address - Phone:765-448-8000
Mailing Address - Fax:765-448-8335
Practice Address - Street 1:2600 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3055
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-7612
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040251A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN249500OtherPHCS PID NUMBER
IN10783741OtherCAQH NUMBER
IN100217120Medicaid
IN000000260431OtherANTHEM PROVIDER NUMBER
IN815460YYMedicare PIN
IN130026197Medicare PIN
INF55148Medicare UPIN
IN815500J3Medicare PIN
IN224390SMedicare PIN