Provider Demographics
NPI:1295298875
Name:DEROOS, MARGARET CLAIRE (DO)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:CLAIRE
Last Name:DEROOS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:CLAIRE
Other - Last Name:CAUDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 SUMMER ROSE LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-5356
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:205 SUMMER ROSE LN
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-5356
Practice Address - Country:US
Practice Address - Phone:256-226-0236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4950207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program