Healthcare Provider Details

I. General information

NPI: 1508890534
Provider Name (Legal Business Name): MARGUERITE AMILIE SELLITTI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

1707 CUMBERLAND FALLS HWY SUITE U2
CORBIN KY
40701-2743
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6486
  • Fax:
Mailing address:
  • Phone: 606-523-2200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number26708
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number26708
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: