Provider Demographics
NPI: | 1972687853 |
---|---|
Name: | MARGOLIS, JUDITH (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | JUDITH |
Middle Name: | |
Last Name: | MARGOLIS |
Suffix: | |
Gender: | F |
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: | 333 W HAMPDEN AVE |
Mailing Address - Street 2: | SUITE #600 |
Mailing Address - City: | ENGLEWOOD |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80110-2330 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-761-5646 |
Mailing Address - Fax: | 303-761-9280 |
Practice Address - Street 1: | 333 W HAMPDEN AVE |
Practice Address - Street 2: | SUITE #600 |
Practice Address - City: | ENGLEWOOD |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80110-2330 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-761-5646 |
Practice Address - Fax: | 303-761-9280 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-10-25 |
Last Update Date: | 2016-05-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | 49291 | 207L00000X |
NC | 38804 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 8953931 | Medicaid | |
OH | 1972687853 | Medicaid | |
CO | 83874836 | Medicaid | |
NC | 8953931 | Medicaid | |
CO | 83874836 | Medicaid | |
NC | 2157311D | Medicare PIN | |
CO | COA104716 | Medicare PIN |