Provider Demographics
NPI:1437224623
Name:MARSTELLER, LUISA PORTAL (MD)
Entity Type:Individual
Prefix:DR
First Name:LUISA
Middle Name:PORTAL
Last Name:MARSTELLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 THOMAS CARTWRIGHT
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-8904
Mailing Address - Country:US
Mailing Address - Phone:757-345-5652
Mailing Address - Fax:
Practice Address - Street 1:2221 EDWARD HOLLAND DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2518
Practice Address - Country:US
Practice Address - Phone:804-354-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010411312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology