Provider Demographics
NPI:1134126618
Name:MARGOLIS, MARY A (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
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 1:1801 N SENATE BLVD
Mailing Address - Street 2:SUITE 355
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1228
Mailing Address - Country:US
Mailing Address - Phone:317-924-8420
Mailing Address - Fax:317-924-8424
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:SUITE 355
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-924-8420
Practice Address - Fax:317-924-8424
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023479207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083027OtherANTHEM NUMBER
IND94564Medicare UPIN
IN076330KMedicare ID - Type UnspecifiedMEDICARE NUMBER