Provider Demographics
NPI:1275572778
Name:MARSHALL, ALEXANDER WILLIAMS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:WILLIAMS
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2270 ASHLEY CROSSING DR
Practice Address - Street 2:STE 170
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414
Practice Address - Country:US
Practice Address - Phone:843-763-3700
Practice Address - Fax:843-766-3714
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10625207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC106254Medicaid
SCP00727209OtherRAILROAD MEDICARE ID-RSFPP
SCD177886795Medicare UPIN
SCP00727209OtherRAILROAD MEDICARE ID-RSFPP
SC1558313080Medicare PIN
SC1497874424Medicare PIN
SC106254Medicaid