Provider Demographics
NPI:1588747141
Name:KENNETH MARGOLIS MD AMBULATORY ENDOSCOPY SURGICAL CENTER
Entity type:Organization
Organization Name:KENNETH MARGOLIS MD AMBULATORY ENDOSCOPY SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARGOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-687-0202
Mailing Address - Street 1:9101 FRANKLIN SQUARE DR
Mailing Address - Street 2:SUITE 213
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3936
Mailing Address - Country:US
Mailing Address - Phone:410-687-0202
Mailing Address - Fax:
Practice Address - Street 1:9101 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 213
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3936
Practice Address - Country:US
Practice Address - Phone:410-687-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1128261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA1128OtherMARYLAND LICENSE NUMBER
MDZZ27Medicare ID - Type Unspecified