Provider Demographics
NPI:1619997566
Name:MARSH, JOHN O (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:O
Last Name:MARSH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5715
Mailing Address - Fax:540-224-5684
Practice Address - Street 1:36 CHERRY GROVE ROAD
Practice Address - Street 2:
Practice Address - City:MIDDLEBROOK
Practice Address - State:VA
Practice Address - Zip Code:24459
Practice Address - Country:US
Practice Address - Phone:540-887-2627
Practice Address - Fax:540-886-2726
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2022-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101037747207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005621852Medicaid
VAF48519Medicare UPIN
VA005621852Medicaid
VAC10946Medicare PIN