Provider Demographics
NPI:1497869002
Name:MARSHALL, BERNARD A
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:A
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21922
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27420-1922
Mailing Address - Country:US
Mailing Address - Phone:336-275-6401
Mailing Address - Fax:336-272-6578
Practice Address - Street 1:802 GREEN VALLEY RD
Practice Address - Street 2:STE. 108
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7041
Practice Address - Country:US
Practice Address - Phone:336-275-6401
Practice Address - Fax:336-272-6578
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21202207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954085Medicaid
NC8954085Medicaid