Provider Demographics
NPI:1861460057
Name:MARSHALL, JOHN TALMADGE (MD,PC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:TALMADGE
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S SYCAMORE ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5802
Mailing Address - Country:US
Mailing Address - Phone:804-862-3333
Mailing Address - Fax:804-862-3398
Practice Address - Street 1:700 S SYCAMORE ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5802
Practice Address - Country:US
Practice Address - Phone:804-862-3333
Practice Address - Fax:804-862-3398
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037608207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010146976Medicaid
VA010146976Medicaid
VAE57724Medicare UPIN