Provider Demographics
NPI:1952374571
Name:MARGOSSIAN, HAGOP (MD)
Entity Type:Individual
Prefix:
First Name:HAGOP
Middle Name:
Last Name:MARGOSSIAN
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 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:215-745-4100
Mailing Address - Fax:215-745-9565
Practice Address - Street 1:700 COTTMAN AVE
Practice Address - Street 2:BLDG. B, STE 101
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-745-4100
Practice Address - Fax:215-745-9565
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061993L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001824234Medicaid
PA042709GT6Medicare PIN