Provider Demographics
NPI:1932133030
Name:GUILL, MARSHALL ANDERSON III (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:ANDERSON
Last Name:GUILL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC DEPART OF MEDICINE/DERMATOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-5000
Mailing Address - Fax:
Practice Address - Street 1:18 OLD ETNA RD
Practice Address - Street 2:DH DEPT OF DERMATOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766
Practice Address - Country:US
Practice Address - Phone:603-650-3100
Practice Address - Fax:603-650-3174
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAG16239207N00000X
NH14454207N00000X, 207NS0135X
GAGA16239207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30209308Medicaid
GA070008491OtherRAILROAD MEDICARE
VT1017229Medicaid
NH30209308Medicaid
NH001450801Medicare PIN
D45510Medicare UPIN