MEDICARE: MARK MARGOLIES OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	OEG000972	PA
2	152W00000X	Optometrist	OEG000972	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410024019	OTHER	PA	RAILROAD MEDICARE PROVIDER NUMBER/PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043216898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK MARGOLIES OD

Provider Business Mailing Address
First Line	:	1724 KENDRICK ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-1816
Country	:	US
Telephone Number	:	215-946-1221
Fax Number	:	215-946-1225

Provider Business Practice Location Address
First Line	:	29 STONYBROOK DR
Second Line	:
City	:	LEVITTOWN
State	:	PA
Zip	:	19055-2216
Country	:	US
Telephone Number	:	215-946-1221
Fax Number	:	215-946-1225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	06/30/2010

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Directions to “ MARK MARGOLIES OD” Practice Location

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