Healthcare Provider Details

I. General information

NPI: 1821062084
Provider Name (Legal Business Name): JOHN L MARGOLIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 D KENNEDY MEMORIAL DR
WATERVILLE ME
04901
US

IV. Provider business mailing address

325 D KENNEDY MEMORIAL DR
WATERVILLE ME
04901
US

V. Phone/Fax

Practice location:
  • Phone: 207-873-4055
  • Fax: 207-873-5243
Mailing address:
  • Phone: 207-873-4055
  • Fax: 207-873-5243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11537
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: