Provider Demographics
NPI:1043369465
Name:GINDER MARSHALL, M.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:GINDER MARSHALL, M.D., A PROFESSIONAL CORPORATION
Other - Org Name:GINDER MARSHALL, M.D., APC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-673-8372
Mailing Address - Street 1:655 E QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1930
Mailing Address - Country:US
Mailing Address - Phone:310-673-8372
Mailing Address - Fax:310-673-3270
Practice Address - Street 1:655 E QUEEN ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1930
Practice Address - Country:US
Practice Address - Phone:310-673-8372
Practice Address - Fax:310-673-3270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58889207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19653Medicare ID - Type UnspecifiedGROUP ID