Provider Demographics
NPI:1891994836
Name:MARGOLIN MD PA
Entity Type:Organization
Organization Name:MARGOLIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:MARGOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-442-2193
Mailing Address - Street 1:501 S LINCOLN AVE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5945
Mailing Address - Country:US
Mailing Address - Phone:727-442-2193
Mailing Address - Fax:727-466-6483
Practice Address - Street 1:501 S LINCOLN AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5945
Practice Address - Country:US
Practice Address - Phone:727-442-2193
Practice Address - Fax:727-466-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL049423200Medicaid
FL71551Medicare PIN
FL049423200Medicaid