Provider Demographics
NPI:1861476533
Name:WAITZ, MARGOT (DO)
Entity Type:Individual
Prefix:
First Name:MARGOT
Middle Name:
Last Name:WAITZ
Suffix:
Gender:F
Credentials:DO
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 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7170
Mailing Address - Country:US
Mailing Address - Phone:302-623-7262
Mailing Address - Fax:302-623-7374
Practice Address - Street 1:1401 FOULK RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2763
Practice Address - Country:US
Practice Address - Phone:302-477-3300
Practice Address - Fax:302-477-3168
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20003315207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE010998F29Medicare PIN
DEF95635Medicare UPIN