Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 406 | ME |
Y | 103T00000X | Psychologist | 406 | ME |
NPI | 1013984335 |
---|---|
Provider Name | Dr. David Margolis |
First Address | Portland, ME 04103-2681 |
Second Address | Portland, ME 04103-3427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2006 |
Last Update Date | 23/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
115710000 | (05) | ME |