Provider Demographics
NPI:1760952634
Name:MARGERUM, STANLEY J (LMBT)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:J
Last Name:MARGERUM
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 LEXINGTON FARM RD
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-5306
Mailing Address - Country:US
Mailing Address - Phone:203-223-2421
Mailing Address - Fax:
Practice Address - Street 1:309 S ELM ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-1801
Practice Address - Country:US
Practice Address - Phone:919-694-7221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-04
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16650225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist