Provider Demographics
NPI:1356471247
Name:JOHN T. MARSHALL M.D P.C
Entity Type:Organization
Organization Name:JOHN T. MARSHALL M.D P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:TALMADGE
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-862-3333
Mailing Address - Street 1:700 S SYCAMORE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5802
Mailing Address - Country:US
Mailing Address - Phone:804-862-3333
Mailing Address - Fax:804-862-3398
Practice Address - Street 1:700 S SYCAMORE ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5802
Practice Address - Country:US
Practice Address - Phone:804-862-3333
Practice Address - Fax:804-862-3398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037608261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010146976Medicaid
VA010146976Medicaid
VAE57724Medicare UPIN