Provider Demographics
NPI:1841228947
Name:MARSHALL, ERIC CORNELIUS (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CORNELIUS
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:70 RHODE ISLAND AVE NW APT 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1064
Mailing Address - Country:US
Mailing Address - Phone:202-607-5298
Mailing Address - Fax:202-330-5356
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 117
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-832-7007
Practice Address - Fax:240-425-4636
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263962207Q00000X
WV29364207Q00000X
MO2018032594207Q00000X
MA277082207Q00000X
MDM49221207Q00000X
IN01079991B207Q00000X
MI5135091205207Q00000X
AK133474207Q00000X
DCCS0112180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2185209OtherUNITED HEALTHCARE
DC033890700Medicaid
DC2680223-7710244OtherAETNA US HEALTHCARE
3873549-001OtherCIGNA
246302OtherANTHEM JOHNSON AVENUE
19665OtherJOHNS HOPKINS HEALTHCARE LLC EHP
KP29GEOtherCAREFIRST
AK1700801Medicaid
MD69230200Medicaid
246299OtherANTHEM VARNUM STREET
94133OtherAMERIGROUP (ANTHEM)