Provider Demographics
NPI:1891834164
Name:MARGARITA M AND ROBERT G SHULTZ
Entity Type:Organization
Organization Name:MARGARITA M AND ROBERT G SHULTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:SHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-393-5891
Mailing Address - Street 1:1300 MILLERSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-6614
Mailing Address - Country:US
Mailing Address - Phone:717-393-5891
Mailing Address - Fax:717-393-3774
Practice Address - Street 1:1300 MILLERSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-6614
Practice Address - Country:US
Practice Address - Phone:717-393-5891
Practice Address - Fax:717-393-3774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009048E207RE0101X
PAMD011168E2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02364000OtherCAPITAL BLUE CROSS
PA644902Medicare ID - Type Unspecified