Provider Demographics
NPI:1477575835
Name:MARGULIES, THOMAS DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DANIEL
Last Name:MARGULIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 W STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-3663
Mailing Address - Country:US
Mailing Address - Phone:541-618-6443
Mailing Address - Fax:541-618-6452
Practice Address - Street 1:229 W STEWART AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-3663
Practice Address - Country:US
Practice Address - Phone:541-618-6443
Practice Address - Fax:541-618-6452
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD19955207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR081757Medicaid
ORR105049OtherMEDICARE GROUP PIN
ORR105706OtherMEDICARE GRP/FPGPC
OR170051OtherMEDICAID GROUP
OR081757Medicaid
ORR136057Medicare PIN
ORR105049OtherMEDICARE GROUP PIN