Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 221275-01 | NY |
N | 207RC0200X | Critical Care Medicine | 3894 | AZ |
NPI | 1033194998 |
---|---|
Provider Name | Gregory M Margolin |
First Address | Phoenix, AZ 85012-2369 |
Second Address | Phoenix, AZ 85012-2369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 08/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
784878 | (05) | AZ |
H85606 | (02) |