Provider Demographics
NPI:1720144165
Name:MARGUT, SHELBY LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELBY
Middle Name:LEE
Last Name:MARGUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:120 S TAN ALY STE 1
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17026-9349
Mailing Address - Country:US
Mailing Address - Phone:717-865-6644
Mailing Address - Fax:717-865-5666
Practice Address - Street 1:120 S. TAN ST., SUITE 1
Practice Address - Street 2:FREDERICKSBURG COMMUNITY HEALTH CENTER, P.C.
Practice Address - City:FREDERICKSBURG
Practice Address - State:PA
Practice Address - Zip Code:17026-0009
Practice Address - Country:US
Practice Address - Phone:717-865-6644
Practice Address - Fax:717-865-7321
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD431135207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019274770001Medicaid
PAMA1969221OtherHIGHMARK B/S
PA50070907OtherCAPITAL B/C
PA112267HE2Medicare PIN