Provider Demographics
NPI:1083696330
Name:MARSHALL, MANLY ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:MANLY
Middle Name:ERNEST
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 COX BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9479
Mailing Address - Country:US
Mailing Address - Phone:919-580-0000
Mailing Address - Fax:919-580-0209
Practice Address - Street 1:203 COX BLVD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9479
Practice Address - Country:US
Practice Address - Phone:919-580-0000
Practice Address - Fax:919-580-0209
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21077207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890252EMedicaid
NC2310707Medicare ID - Type Unspecified