Provider Demographics
NPI:1326197963
Name:MARSHALL, MARK J (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:MARSHALL
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Gender:M
Credentials:DO
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Mailing Address - Street 1:50 HOSPITAL HILL RD
Mailing Address - Street 2:SHARON HOSPITAL
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-2096
Mailing Address - Country:US
Mailing Address - Phone:860-364-4201
Mailing Address - Fax:860-364-4211
Practice Address - Street 1:50 HOSPITAL HILL RD
Practice Address - Street 2:SHARON HOSPITAL
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2096
Practice Address - Country:US
Practice Address - Phone:860-364-4201
Practice Address - Fax:860-364-4211
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CT000529207R00000X
NY203678207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTG88232Medicare UPIN