Provider Demographics
NPI:1730251257
Name:PROCTOR, MARGARET SELFRIDGE (MD)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:SELFRIDGE
Last Name:PROCTOR
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 1:700 W LEA BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19802-2500
Mailing Address - Country:US
Mailing Address - Phone:302-762-5656
Mailing Address - Fax:302-762-5699
Practice Address - Street 1:700 W LEA BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2500
Practice Address - Country:US
Practice Address - Phone:302-762-5656
Practice Address - Fax:302-762-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004810208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821116179OtherNPI GROUP NUMBER