Provider Demographics
NPI:1619178308
Name:MARGOLIN, LEON (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:
Last Name:MARGOLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5245 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-2503
Mailing Address - Country:US
Mailing Address - Phone:718-530-5953
Mailing Address - Fax:614-453-8222
Practice Address - Street 1:5245 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2503
Practice Address - Country:US
Practice Address - Phone:718-530-5953
Practice Address - Fax:614-453-8222
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090064208VP0000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2852579Medicaid
9391481OtherPTAN
OH2852579Medicaid