Provider Demographics
NPI:1295760841
Name:MARGOLIS, AMY JILL (DO)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:JILL
Last Name:MARGOLIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:MARGOLIS
Other - Last Name:DELORIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 PARKLAND DR
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-2746
Mailing Address - Country:US
Mailing Address - Phone:603-421-2220
Mailing Address - Fax:603-421-2223
Practice Address - Street 1:1 PARKLAND DR
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:NH
Practice Address - Zip Code:03038-2746
Practice Address - Country:US
Practice Address - Phone:603-421-2220
Practice Address - Fax:603-421-2223
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12420207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30223131Medicaid
MA2091640Medicaid
7769481OtherAETNA
NH04Y007571NH02OtherANTHEM
ME432640599Medicaid
NH7769481OtherAETNA
P00190750OtherRAILROAD MEDICARE
NH04Y007571NH03OtherBCBS OF NH
NH04Y007571NH03OtherBCBS OF NH
NH04Y007571NH02OtherANTHEM
NHH86810Medicare UPIN
ME432640599Medicaid