Basic Information
Provider Information
NPI: 1235348822
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOMPLE
FirstName: MARGARET
MiddleName: D
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1330 COSHOCTON AVE
Address2:  
City: MOUNT VERNON
State: OH
PostalCode: 43050
CountryCode: US
TelephoneNumber: 7403939000
FaxNumber: 7403920167
Practice Location
Address1: 1330 COSHOCTON AVE
Address2:  
City: MOUNT VERNON
State: OH
PostalCode: 43050
CountryCode: US
TelephoneNumber: 7403939000
FaxNumber: 7403920167
Other Information
ProviderEnumerationDate: 05/21/2007
LastUpdateDate: 12/08/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/08/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X58.001783OHN Allopathic & Osteopathic PhysiciansPediatrics 
208000000X34009056OHY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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