Provider Demographics
NPI:1619199346
Name:MARGOLIS, PETER A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:A
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 BURNET AVE., MEDICAL OFFICE BLDG, 2ND FLOOR
Mailing Address - Street 2:ML 5026
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-7722
Mailing Address - Fax:513-636-3737
Practice Address - Street 1:3430 BURNET AVE., MEDICAL OFFICE BLDG, 2ND FLOOR
Practice Address - Street 2:ML 5026
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-7722
Practice Address - Fax:513-636-3737
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.088777208000000X
NC31577208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics