Provider Demographics
NPI:1245213891
Name:MARSHALL, EDWIN (MD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
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:PMB 202, PO BOX 70005
Mailing Address - Street 2:
Mailing Address - City:FAJARDO
Mailing Address - State:PR
Mailing Address - Zip Code:00738
Mailing Address - Country:US
Mailing Address - Phone:787-860-0075
Mailing Address - Fax:787-863-6246
Practice Address - Street 1:375 AVE GEN VALERO
Practice Address - Street 2:SUITE 105
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4893
Practice Address - Country:US
Practice Address - Phone:787-860-0075
Practice Address - Fax:787-863-6246
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8326207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08572Medicare UPIN
0029386Medicare ID - Type Unspecified