Provider Demographics
NPI:1730645458
Name:MARSHALL PEDIATRICS INC
Entity Type:Organization
Organization Name:MARSHALL PEDIATRICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-217-9393
Mailing Address - Street 1:204 PERIDOT DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:OH
Mailing Address - Zip Code:45302-8632
Mailing Address - Country:US
Mailing Address - Phone:937-217-9393
Mailing Address - Fax:
Practice Address - Street 1:322 2ND AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1263
Practice Address - Country:US
Practice Address - Phone:937-217-9393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty