Provider Demographics
NPI:1689760811
Name:MEDOWS, MARSHA ELLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHA
Middle Name:ELLEN
Last Name:MEDOWS
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 1:550-H GRAND STREET
Mailing Address - Street 2:APARTMENT 1D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-4380
Mailing Address - Country:US
Mailing Address - Phone:646-479-4426
Mailing Address - Fax:
Practice Address - Street 1:760 BROADWAY
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS, 6TH FLOOR; WOODHULL HOSPITAL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-5317
Practice Address - Country:US
Practice Address - Phone:718-963-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics