MEDICARE: DR. LAURA J MARGOLIS PH.D.

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	103TC0700X	Clinical Psychologist	02966	MD
2	103TC2200X	Clinical Child & Adolescent Psychologist	02966	MD

General Provider Information

NPI Number	:	1073634317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURA J MARGOLIS PH.D.

Provider Business Mailing Address
First Line	:	5516 EMORY RD
Second Line	:
City	:	UPPERCO
State	:	MD
Zip	:	21155-9755
Country	:	US
Telephone Number	:	410-241-4133
Fax Number	:

Provider Business Practice Location Address
First Line	:	3454 ELLICOTT CENTER DR STE 106
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-4130
Country	:	US
Telephone Number	:	410-461-3760
Fax Number	:

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	09/11/2025

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