Provider Demographics
NPI:1477558716
Name:MARSLAND, THOMAS A (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:MARSLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 LYNCH CREEK WAY STE A
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-2337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:110 LYNCH CREEK WAY STE A
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-763-0600
Practice Address - Fax:707-765-1757
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMD 36755207RH0003X
CAG140901207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068732400Medicaid
FL900429OtherWELLCARE
FLP0026506OtherFLORIDA HEALTHCARE PLUS
FL0049336OtherCIGNA
FLP01383299OtherRR MEDICARE
FL4199901OtherAETNA
FL1107969OtherCARE PLUS HEALTH PLANS
FL15581OtherBCBS
FL16810OtherWELLCARE
FL202563OtherAVMED
FLP01327658OtherRR MEDICARE
FLP1004617OtherFREEDOM HEALTH
FLP01383299OtherRR MEDICARE
FL15581EMedicare PIN
FL15581SMedicare PIN
FL0049336OtherCIGNA
FLP1004617OtherFREEDOM HEALTH
FL900429OtherWELLCARE
FL15581TMedicare PIN
FL16810OtherWELLCARE
FL068732400Medicaid
FL15581OtherBCBS
FL202563OtherAVMED