MEDICARE: MARY A MARGOLIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	01023479	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000083027	OTHER	IN	ANTHEM NUMBER

General Provider Information

NPI Number	:	1134126618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY A MARGOLIS M.D.

Provider Business Mailing Address
First Line	:	1801 N SENATE BLVD
Second Line	:	SUITE 355
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1228
Country	:	US
Telephone Number	:	317-924-8420
Fax Number	:	317-924-8424

Provider Business Practice Location Address
First Line	:	1801 N SENATE BLVD
Second Line	:	SUITE 355
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-1228
Country	:	US
Telephone Number	:	317-924-8420
Fax Number	:	317-924-8424

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/09/2007

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