Provider Demographics
NPI:1083739130
Name:MARGOLIN, ROBERT J (M D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:MARGOLIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 CLAY ST FL 6
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1932
Mailing Address - Country:US
Mailing Address - Phone:415-600-3700
Mailing Address - Fax:925-600-3705
Practice Address - Street 1:4425C TREAT BLVD STE 243
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2703
Practice Address - Country:US
Practice Address - Phone:925-685-4854
Practice Address - Fax:925-685-8750
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50108174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9425838839OtherTAX ID
CA00G501080Medicaid
CA00501080Medicare ID - Type UnspecifiedMEDICARE
CA00G501080Medicaid