Healthcare Provider Details

I. General information

NPI: 1649350554
Provider Name (Legal Business Name): DAVID I MARGOLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E ALLUVIAL AVE STE 101
FRESNO CA
93720-3832
US

IV. Provider business mailing address

PO BOX 25042
FRESNO CA
93729-5042
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-1245
  • Fax: 559-261-2968
Mailing address:
  • Phone: 559-438-1245
  • Fax: 559-261-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG50321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: