Provider Demographics
NPI:1063544450
Name:MARGULIS, PETER JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:MARGULIS
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 1:30 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14214-2603
Mailing Address - Country:US
Mailing Address - Phone:716-939-2614
Mailing Address - Fax:716-939-2597
Practice Address - Street 1:30 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-2603
Practice Address - Country:US
Practice Address - Phone:716-939-2614
Practice Address - Fax:716-939-2597
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010383742084P0800X
NY172155-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100148310Medicaid
INE61408Medicare UPIN