Provider Demographics
NPI:1639139660
Name:FRETWELL, MARSHA D (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:D
Last Name:FRETWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1013 PORTERS NECK RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28411-8130
Mailing Address - Country:US
Mailing Address - Phone:910-686-1099
Mailing Address - Fax:910-686-4715
Practice Address - Street 1:1013 PORTERS NECK RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-8130
Practice Address - Country:US
Practice Address - Phone:910-686-1099
Practice Address - Fax:910-686-4715
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9401190207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890164HMedicaid
NC890164HMedicaid
NCC89821Medicare UPIN