Provider Demographics
NPI:1528034865
Name:MARSHALL, KATHLEEN MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MICHELLE
Last Name:MARSHALL
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:804-285-0088
Practice Address - Street 1:601 POTOMAC STATION DR NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1816
Practice Address - Country:US
Practice Address - Phone:703-840-1396
Practice Address - Fax:804-378-7728
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME141661207Q00000X
VA0101247204207Q00000X
GA83392207Q00000X
KY52860207Q00000X
CT63817207Q00000X
LA312663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02543039Medicaid
NYI00189Medicare UPIN
NY02543039Medicaid