Provider Demographics
NPI:1144558834
Name:MAGDOVITZ, NOUTH CHANMANIVONE (MD)
Entity type:Individual
Prefix:DR
First Name:NOUTH
Middle Name:CHANMANIVONE
Last Name:MAGDOVITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 SANDERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4332
Mailing Address - Country:US
Mailing Address - Phone:901-683-9371
Mailing Address - Fax:901-761-1979
Practice Address - Street 1:5050 SANDERLIN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4332
Practice Address - Country:US
Practice Address - Phone:901-683-9371
Practice Address - Fax:901-761-1979
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43741208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics