Provider Demographics
NPI:1174536452
Name:KOENIG, MARGARET A (RD, LD, CDE)
Entity type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:A
Last Name:KOENIG
Suffix:
Gender:F
Credentials:RD, LD, CDE
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:A
Other - Last Name:BOLDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6190 DEER HOLW
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216-8674
Mailing Address - Country:US
Mailing Address - Phone:330-472-0999
Mailing Address - Fax:
Practice Address - Street 1:4565 DRESSLER RD NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2549
Practice Address - Country:US
Practice Address - Phone:330-493-0013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD702133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBOMT70361Medicare ID - Type UnspecifiedPROVIDER NUMBER