Provider Demographics
NPI:1669518247
Name:MARGOLIS, SANDRA JILL (NP)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JILL
Last Name:MARGOLIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CHRISTINA ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1915
Mailing Address - Country:US
Mailing Address - Phone:617-964-4691
Mailing Address - Fax:
Practice Address - Street 1:259 SWANTON ST STE A
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:MA
Practice Address - Zip Code:01890-4301
Practice Address - Country:US
Practice Address - Phone:781-721-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232926363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MANP2535OtherBCBSMA
MA0393941OtherMASSHEALTH
MANP2535OtherBCBSMA
MANP2535Medicare ID - Type Unspecified