Provider Demographics
NPI:1346561933
Name:MARSHAK MEDICAL GROUP,LLC
Entity Type:Organization
Organization Name:MARSHAK MEDICAL GROUP,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARSHAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-917-2185
Mailing Address - Street 1:9900 BELWARD CAMPUS DR
Mailing Address - Street 2:SUITE 325
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3969
Mailing Address - Country:US
Mailing Address - Phone:301-917-2185
Mailing Address - Fax:301-917-2191
Practice Address - Street 1:9900 BELWARD CAMPUS DR
Practice Address - Street 2:SUITE 325
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3969
Practice Address - Country:US
Practice Address - Phone:301-917-2185
Practice Address - Fax:301-917-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068171207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG84855Medicare UPIN