Provider Demographics
NPI:1114925112
Name:WAREHAM, MARSHALL CLAUDE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:CLAUDE
Last Name:WAREHAM
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 1:5250 FAR HILLS AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2382
Mailing Address - Country:US
Mailing Address - Phone:937-433-2300
Mailing Address - Fax:937-433-0210
Practice Address - Street 1:5250 FAR HILLS AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2382
Practice Address - Country:US
Practice Address - Phone:937-433-2300
Practice Address - Fax:937-433-0210
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-05-0634-W207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311026469027OtherCARESOURCE
OH0770134Medicaid
OH180011133OtherRAILROAD MEDICARE
OH22364OtherCOLE VISION
OH000000189353OtherANTHEM BC/BS
OH311026469027OtherCARESOURCE
OHC03467Medicare UPIN