Provider Demographics
NPI:1760478424
Name:AMEIGH, MARGRETTA JOHNSON (MD)
Entity Type:Individual
Prefix:
First Name:MARGRETTA
Middle Name:JOHNSON
Last Name:AMEIGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARGRETTA
Other - Middle Name:ANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:1515 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:NEW CUMBERLAND
Practice Address - State:PA
Practice Address - Zip Code:17070-1120
Practice Address - Country:US
Practice Address - Phone:717-695-4084
Practice Address - Fax:717-695-3963
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034246E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015799060007Medicaid
PA544391F6KOtherMEDICARE
PA15799601Medicaid