Provider Demographics
NPI:1982685285
Name:MAYO, MARGARET G (MD)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:G
Last Name:MAYO
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 1:22091 ELMIRA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-7018
Mailing Address - Country:US
Mailing Address - Phone:941-624-4748
Mailing Address - Fax:941-324-4201
Practice Address - Street 1:22091 ELMIRA BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-7018
Practice Address - Country:US
Practice Address - Phone:941-624-4748
Practice Address - Fax:941-324-4201
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME57311208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE20493Medicare UPIN