Provider Demographics
NPI:1265503643
Name:HASWELL, MARVIN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:SCOTT
Last Name:HASWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1907
Mailing Address - Country:US
Mailing Address - Phone:765-962-9541
Mailing Address - Fax:765-966-5952
Practice Address - Street 1:1050 REID PARKWAY
Practice Address - Street 2:SUITE 220
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1160
Practice Address - Country:US
Practice Address - Phone:765-962-9541
Practice Address - Fax:765-966-5952
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038245207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100257020AMedicaid
E66934Medicare UPIN
IN100257020AMedicaid