Provider Demographics
NPI:1376548636
Name:MARGOLIS, RANDI D (DPM)
Entity Type:Individual
Prefix:DR
First Name:RANDI
Middle Name:D
Last Name:MARGOLIS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 RIVERSIDE WAY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1284
Mailing Address - Country:US
Mailing Address - Phone:561-666-7757
Mailing Address - Fax:561-496-6739
Practice Address - Street 1:3770 RIVERSIDE WAY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-1284
Practice Address - Country:US
Practice Address - Phone:561-666-7757
Practice Address - Fax:561-496-6739
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3857213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAH184AOtherMEDICARE PTAN
CA21628Medicare UPIN
FLAH184AOtherMEDICARE PTAN