Provider Demographics
NPI:1588640981
Name:MARSHALL, BRIAN W (DO)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:W
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4916 WESTMINSTER LN
Mailing Address - Street 2:
Mailing Address - City:BROADVIEW HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44147-2069
Mailing Address - Country:US
Mailing Address - Phone:440-526-9876
Mailing Address - Fax:440-526-9876
Practice Address - Street 1:863 W AURORA RD
Practice Address - Street 2:SAGAMORE HILLS ED
Practice Address - City:SAGAMORE HILLS
Practice Address - State:OH
Practice Address - Zip Code:44067-1603
Practice Address - Country:US
Practice Address - Phone:330-468-0190
Practice Address - Fax:330-467-2283
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34006119207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2528152Medicaid
G04917Medicare UPIN
OHMA0784338Medicare ID - Type Unspecified