Healthcare Provider Details

I. General information

NPI: 1720216856
Provider Name (Legal Business Name): MARGARET M HURST D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARGARET M PROVOST D.O.

II. Dates (important events)

Enumeration Date: 06/27/2009
Last Update Date: 06/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BOUNDARY DRIVE
LUTES MOUNTAIN NEW BRUNSWICK
E1G 5C6
CA

IV. Provider business mailing address

125 BOUNDARY DRIVE
LUTES MOUNTAIN NEW BRUNSWICK
E1G 5C6
CA

V. Phone/Fax

Practice location:
  • Phone: 506-382-7570
  • Fax: 506-857-3896
Mailing address:
  • Phone: 506-382-7570
  • Fax: 506-857-3896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1733
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9801309
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0481
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: