Provider Demographics
NPI:1114981982
Name:CUSHMAN, MARSHA LYNNE (DO)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:LYNNE
Last Name:CUSHMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:934 CLUB LN
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-6106
Mailing Address - Country:US
Mailing Address - Phone:803-934-8044
Mailing Address - Fax:
Practice Address - Street 1:950 W WOOSTER ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2603
Practice Address - Country:US
Practice Address - Phone:419-354-9810
Practice Address - Fax:419-861-8982
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006687207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000526861OtherANTHEM
OH2085907Medicaid
OH810547599082OtherCARESOURCE
OH000000529311OtherANTHEM
OHCU4178142Medicare PIN
OH000000529311OtherANTHEM
OH000000526861OtherANTHEM
OH810547599082OtherCARESOURCE