Provider Demographics
NPI:1720004658
Name:MARSHALL, REBECCA S (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 GRASSY LN
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1525
Mailing Address - Country:US
Mailing Address - Phone:419-474-4561
Mailing Address - Fax:419-474-4561
Practice Address - Street 1:1215 GRASSY LN
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1525
Practice Address - Country:US
Practice Address - Phone:419-661-9727
Practice Address - Fax:419-661-9730
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2668671Medicaid
OH4188592Medicare PIN