Provider Demographics
NPI:1801846290
Name:MARSHALL, ANDREW TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TODD
Last Name:MARSHALL
Suffix:
Gender:M
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 FARMSTEAD LN
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2602
Mailing Address - Country:US
Mailing Address - Phone:516-898-5625
Mailing Address - Fax:
Practice Address - Street 1:1800 ROCKAWAY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557
Practice Address - Country:US
Practice Address - Phone:516-593-2629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193405207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG45749Medicare UPIN
NY21N641Medicare ID - Type Unspecified