Provider Demographics
NPI:1790866630
Name:SAMUEL J. MARGIOTTA, JR, MD, PA
Entity Type:Organization
Organization Name:SAMUEL J. MARGIOTTA, JR, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARGIOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-784-7000
Mailing Address - Street 1:13005 SOUTHERN BLVD
Mailing Address - Street 2:STE 231
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9206
Mailing Address - Country:US
Mailing Address - Phone:561-784-7000
Mailing Address - Fax:
Practice Address - Street 1:13005 SOUTHERN BLVD
Practice Address - Street 2:STE 231
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9206
Practice Address - Country:US
Practice Address - Phone:561-784-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL94956OtherBLUE CROSS GROUP NUMBER
FLK6372Medicare ID - Type UnspecifiedFL MEDICARE GROUP NUMBER