Basic Information
| Provider Information | |||||||||
| NPI: | 1649350554 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARGOLIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25042 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937295042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594381245 | ||||||||
| FaxNumber: | 5592612968 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 E ALLUVIAL AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937203832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594381245 | ||||||||
| FaxNumber: | 5592612968 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 04/05/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | G50321 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 130010398 | 01 | CA | RAILROAD MEDICARE | OTHER | 00G503211 | 05 | CA | MEDICAID | 00G503211 | 01 | CA | BLUE SHIELD | OTHER |