1790795243 NPI number — DAVID MARGOLIS MD

Table of content: DAVID MARGOLIS MD (NPI 1790795243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790795243 NPI number — DAVID MARGOLIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARGOLIS
Provider First Name:
DAVID
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790795243
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4205 BELFORT RD STE 4015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32216-3623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-450-6014
Provider Business Mailing Address Fax Number:
904-450-6401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9980 CENTRAL PARK BLVD N
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33428-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-488-3113
Provider Business Practice Location Address Fax Number:
561-488-2398
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0102X , with the licence number:  ME60044 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X , with the licence number: ME60044 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 372894300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002643 . This is a "NEIGHBORHOOD HEALTH PARTNERSHIP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 18550 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 200946 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 023883200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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