Provider Demographics
NPI:1437160348
Name:MARGOLIN, M L (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:L
Last Name:MARGOLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MALCOLM
Other - Middle Name:L
Other - Last Name:MARGOLIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 510E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-278-1490
Mailing Address - Fax:310-659-3049
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 510E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-278-1490
Practice Address - Fax:310-659-3049
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21564207VX0000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22659Medicare UPIN
CAWA21564AMedicare PIN