Provider Demographics
NPI:1376961912
Name:MARSHALL, MARILYN KRISTEL (MBBS)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:KRISTEL
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3540 W LOYOLA DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2418
Mailing Address - Country:US
Mailing Address - Phone:504-645-9206
Mailing Address - Fax:
Practice Address - Street 1:79 CORONADO AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-3132
Practice Address - Country:US
Practice Address - Phone:504-645-9206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA306553208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program