Provider Demographics
NPI:1255620753
Name:EASON, MARGARET KELLY (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:KELLY
Last Name:EASON
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:EVMS PEDIATRIC EMERGENCY MEDICINE
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7272
Mailing Address - Fax:757-668-9766
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:EVMS PEDIATRIC EMERGENCY MEDICINE
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7272
Practice Address - Fax:757-668-9766
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101255773207L00000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVH845AOtherMEDICARE PECOS