Provider Demographics
NPI:1831135755
Name:YELLEN, MARSHALL ROSS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:ROSS
Last Name:YELLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10 LYNOAK CV
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2800
Mailing Address - Country:US
Mailing Address - Phone:731-668-2490
Mailing Address - Fax:731-664-4374
Practice Address - Street 1:10 LYNOAK CV
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2800
Practice Address - Country:US
Practice Address - Phone:731-668-2490
Practice Address - Fax:731-664-4374
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000029583208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3381722Medicare PIN
TNG01860Medicare UPIN
TN3824296Medicare PIN