Provider Demographics
NPI:1306876164
Name:MARGOLIS, PETER IRA (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:IRA
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 1:333 S MOORPARK RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1008
Mailing Address - Country:US
Mailing Address - Phone:805-399-2146
Mailing Address - Fax:805-494-8621
Practice Address - Street 1:333 S MOORPARK RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1008
Practice Address - Country:US
Practice Address - Phone:805-399-2146
Practice Address - Fax:805-399-2146
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40308207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG40308OtherSTATE LICENSE
CAG40308OtherSTATE LICENSE
CAG40308Medicare ID - Type Unspecified
CAAM8829573OtherDEA #