Provider Demographics
NPI:1356839849
Name:SHEA, MARGARET MACKENZIE (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MACKENZIE
Last Name:SHEA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20410 OBSERVATION DR STE 102
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6424
Mailing Address - Country:US
Mailing Address - Phone:202-835-2222
Mailing Address - Fax:
Practice Address - Street 1:20410 OBSERVATION DR STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-6424
Practice Address - Country:US
Practice Address - Phone:202-835-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC06863363A00000X, 363AS0400X
DCPA031663363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty