Provider Demographics
NPI:1891943197
Name:DAVID MARGOLIS PH.D. P.A.
Entity Type:Organization
Organization Name:DAVID MARGOLIS PH.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-780-0014
Mailing Address - Street 1:68 BISHOP ST
Mailing Address - Street 2:UNIT #1
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2681
Mailing Address - Country:US
Mailing Address - Phone:207-780-0014
Mailing Address - Fax:
Practice Address - Street 1:68 BISHOP ST
Practice Address - Street 2:UNIT #1
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2681
Practice Address - Country:US
Practice Address - Phone:207-780-0014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-29
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME406103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
003209OtherANTHEM BLUE CROSS
4410460OtherAETNA