Provider Demographics
NPI:1649448648
Name:REVZIN, MARGARITA V (MD)
Entity type:Individual
Prefix:DR
First Name:MARGARITA
Middle Name:V
Last Name:REVZIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGARITA
Other - Middle Name:
Other - Last Name:REVZINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:580 BELDEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06850-1319
Mailing Address - Country:US
Mailing Address - Phone:917-685-4400
Mailing Address - Fax:
Practice Address - Street 1:580 BELDEN HILL RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06850-1319
Practice Address - Country:US
Practice Address - Phone:917-685-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2348292085R0202X, 2085R0202X
CT490982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology