Healthcare Provider Details

I. General information

NPI: 1437160348
Provider Name (Legal Business Name): M L MARGOLIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MALCOLM L MARGOLIN MD

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST SUITE 510E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST SUITE 510E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-278-1490
  • Fax: 310-659-3049
Mailing address:
  • Phone: 310-278-1490
  • Fax: 310-659-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA21564
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberA21564
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: