Healthcare Provider Details

I. General information

NPI: 1417441171
Provider Name (Legal Business Name): MARGARET G SHAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2018
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 ROCKY HILL RD
RONCEVERTE WV
24970-8028
US

IV. Provider business mailing address

3006 MOUNT VERNON RD STE 1075
HURRICANE WV
25526-0318
US

V. Phone/Fax

Practice location:
  • Phone: 321-387-9451
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number34.014095
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: