Provider Demographics
NPI:1649366931
Name:MARGOLES, SANDRA L (M,D,)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:MARGOLES
Suffix:
Gender:F
Credentials:M,D,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 W ELM ST STE 1L
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6418
Mailing Address - Country:US
Mailing Address - Phone:203-869-2939
Mailing Address - Fax:203-717-5378
Practice Address - Street 1:40 W ELM ST STE 1L
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6418
Practice Address - Country:US
Practice Address - Phone:203-869-2939
Practice Address - Fax:203-717-5378
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202853-1208200000X
CT037667208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG03676Medicare UPIN