Provider Demographics
NPI:1154398782
Name:BILLBROUGH, MARGUERITE REGINA (MD)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:REGINA
Last Name:BILLBROUGH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1098 W BALTIMORE PIKE STE 3301
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5139
Mailing Address - Country:US
Mailing Address - Phone:610-522-2822
Mailing Address - Fax:610-522-2880
Practice Address - Street 1:1098 W BALTIMORE PIKE STE 3301
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5139
Practice Address - Country:US
Practice Address - Phone:610-522-2822
Practice Address - Fax:610-522-2880
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044676L207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0466560000OtherKEYSTONE HEALTH PLAN EAST
PA636411OtherBLUE SHIELD
PA01283813101Medicaid
PA01283813101Medicaid
PA0466560000OtherKEYSTONE HEALTH PLAN EAST