MEDICARE: DAVID MARGOLIS PH.D. P.A.

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	103T00000X	Psychologist	406	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	003209	OTHER		ANTHEM BLUE CROSS
2	4410460	OTHER		AETNA

General Provider Information

NPI Number	:	1891943197
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID MARGOLIS PH.D. P.A.

Provider Business Mailing Address
First Line	:	68 BISHOP ST
Second Line	:	UNIT #1
City	:	PORTLAND
State	:	ME
Zip	:	04103-2681
Country	:	US
Telephone Number	:	207-780-0014
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 BISHOP ST
Second Line	:	UNIT #1
City	:	PORTLAND
State	:	ME
Zip	:	04103-2681
Country	:	US
Telephone Number	:	207-780-0014
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. DAVID MARGOLIS
Credential	:	PH.D.
Telephone Number	:	207-780-0014

Provider Enumeration Date	:	08/29/2008
Last Update Date	:	04/11/2016

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