Healthcare Provider Details

I. General information

NPI: 1144292582
Provider Name (Legal Business Name): AMY B MARGOLIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY SEIDENSTICKER PA-C

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 NW SHEVLIN PARK RD
BEND OR
97703-7102
US

IV. Provider business mailing address

PO BOX 1517
PENDLETON OR
97801-0410
US

V. Phone/Fax

Practice location:
  • Phone: 541-706-3843
  • Fax: 541-278-8375
Mailing address:
  • Phone: 541-278-4332
  • Fax: 541-278-8349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 60026246
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA216394
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: