Provider Demographics
NPI:1396788279
Name:MARGOLIS, LAWRENCE W (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:W
Last Name:MARGOLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 ROCKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:CA
Mailing Address - Zip Code:94010-6929
Mailing Address - Country:US
Mailing Address - Phone:650-342-5816
Mailing Address - Fax:
Practice Address - Street 1:135 ROCKRIDGE RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:CA
Practice Address - Zip Code:94010-6929
Practice Address - Country:US
Practice Address - Phone:650-342-5816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC277462085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C277460Medicaid
CA00C277460Medicare PIN
CA00C277460Medicaid