Provider Demographics
NPI:1881667483
Name:MARSHALL, MALLIKA JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:MALLIKA
Middle Name:JOY
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:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-884-8302
Mailing Address - Fax:617-887-3704
Practice Address - Street 1:151 EVERETT AVE
Practice Address - Street 2:CHC, CHELSEA HEALTHCARE CENTER URGENT CARE
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150
Practice Address - Country:US
Practice Address - Phone:617-884-8302
Practice Address - Fax:617-887-3704
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157854207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22202OtherBCBS MA
MA0124702Medicaid
MA404792OtherTUFTS HEALTH PLAN
MA404792OtherTUFTS HEALTH PLAN
MAJ22202OtherBCBS MA