Healthcare Provider Details

I. General information

NPI: 1013968932
Provider Name (Legal Business Name): JERRY MARGULIES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1057 SECOND STREET PIKE
RICHBORO PA
18954-1803
US

IV. Provider business mailing address

41 UNIVERSITY DR SUITE 300
NEWTOWN PA
18940-1873
US

V. Phone/Fax

Practice location:
  • Phone: 215-710-2770
  • Fax: 215-710-2772
Mailing address:
  • Phone: 215-710-5522
  • Fax: 215-710-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS004706L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: