Provider Demographics
NPI:1952391047
Name:MARGOLIN, DAVID HARRIS (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HARRIS
Last Name:MARGOLIN
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:15 PARKMAN ST
Practice Address - Street 2:WAC 835
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3117
Practice Address - Country:US
Practice Address - Phone:617-726-7643
Practice Address - Fax:617-726-6991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA79554207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3187152Medicaid
MA768664OtherTUFTS HEALTH PLAN
MAJ19540OtherBCBS MA
G80986Medicare UPIN
MAA28911Medicare ID - Type Unspecified