Provider Demographics
NPI:1730302514
Name:BERTHOLF, MARSHA F (MD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:F
Last Name:BERTHOLF
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 1:7595 CENTURION PKWY
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-0518
Mailing Address - Country:US
Mailing Address - Phone:904-353-8263
Mailing Address - Fax:904-358-7111
Practice Address - Street 1:7595 CENTURION PKWY
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0518
Practice Address - Country:US
Practice Address - Phone:904-353-8263
Practice Address - Fax:904-358-7111
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54361207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine