Provider Demographics
NPI:1013271477
Name:MARSHALL, ELISE HELENE (DO)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:HELENE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:HELENE
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 80426
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37414-7426
Mailing Address - Country:US
Mailing Address - Phone:423-495-3671
Mailing Address - Fax:214-429-2671
Practice Address - Street 1:605 GLENWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1144
Practice Address - Country:US
Practice Address - Phone:423-495-2690
Practice Address - Fax:423-495-2698
Is Sole Proprietor?:No
Enumeration Date:2012-06-30
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014868207R00000X
TN2874207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I117217Medicare PIN