Provider Demographics
NPI:1780655043
Name:MARSHALL, REBECCA G (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:G
Last Name:MARSHALL
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 1:16 SPARROW CT
Mailing Address - Street 2:
Mailing Address - City:SKILLMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08558-1636
Mailing Address - Country:US
Mailing Address - Phone:908-874-4569
Mailing Address - Fax:
Practice Address - Street 1:301 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-3512
Practice Address - Country:US
Practice Address - Phone:609-924-5510
Practice Address - Fax:609-924-3577
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA69497208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8042209Medicaid