Provider Demographics
NPI:1881679280
Name:FEGLEY, MICHELLE LEE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LEE
Last Name:FEGLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1575 HIGHLANDS DR STE 101
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-7507
Practice Address - Country:US
Practice Address - Phone:717-393-1338
Practice Address - Fax:717-625-7908
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2020-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052881207V00000X
PAMD451404207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006211691Medicaid
G71121Medicare UPIN
VA006211691Medicaid