Healthcare Provider Details

I. General information

NPI: 1891994836
Provider Name (Legal Business Name): MARGOLIN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S LINCOLN AVE SUITE 26
CLEARWATER FL
33756-5945
US

IV. Provider business mailing address

501 S LINCOLN AVE SUITE 26
CLEARWATER FL
33756-5945
US

V. Phone/Fax

Practice location:
  • Phone: 727-442-2193
  • Fax: 727-466-6483
Mailing address:
  • Phone: 727-442-2193
  • Fax: 727-466-6483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JERRY ALAN MARGOLIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-442-2193