Provider Demographics
NPI:1730153461
Name:MARGOLIS, THOMAS I (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:I
Last Name:MARGOLIS
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 1:1500 TILTON RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08225-1827
Mailing Address - Country:US
Mailing Address - Phone:609-646-5200
Mailing Address - Fax:609-646-9868
Practice Address - Street 1:1500 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1827
Practice Address - Country:US
Practice Address - Phone:609-646-5200
Practice Address - Fax:609-646-9868
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05731100207W00000X, 207WX0107X
PAMD045438L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7297106Medicaid
F21325Medicare UPIN
NJMA715639Medicare ID - Type Unspecified
NJMA715639Medicare PIN