Provider Demographics
NPI:1902030794
Name:MARSHALL, CAMERON (MD)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:622 W 168TH ST PH 5133
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3720
Mailing Address - Country:US
Mailing Address - Phone:413-884-5059
Mailing Address - Fax:212-305-3204
Practice Address - Street 1:1790 BROADWAY
Practice Address - Street 2:15TH FLOOR, SUITE 1500
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-305-7114
Practice Address - Fax:212-305-8883
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271692207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine