Provider Demographics
NPI:1326014549
Name:MARSHALL, RANETTE Y (DO)
Entity Type:Individual
Prefix:DR
First Name:RANETTE
Middle Name:Y
Last Name:MARSHALL
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 1:5100 AUTH WAY
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4207
Mailing Address - Country:US
Mailing Address - Phone:301-702-5000
Mailing Address - Fax:
Practice Address - Street 1:5100 AUTH WAY
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-4207
Practice Address - Country:US
Practice Address - Phone:301-702-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-7633207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB776OtherBCBS NCA GROUP #
OH2253449Medicaid
MDKR10MEOtherBCBS MD GROUP#
MD1851473722OtherGROUP NPI# - MEDICAL AND SURGICAL CLINICS OF SOUTHERN MARYLAND
MDKR10OtherMEDICARE GROUP PIN
MD1366644197OtherGROUP NPI# - WALDORF OB/GYN
MD1366644197OtherGROUP NPI# - WALDORF OB/GYN
MDKR10MEOtherBCBS MD GROUP#
DCB776OtherBCBS NCA GROUP #