Provider Demographics
NPI:1184691156
Name:MARSHALL, STEFANIE N (DO)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:N
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:N
Other - Last Name:KERSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4735 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 1109
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2072
Mailing Address - Country:US
Mailing Address - Phone:302-454-9800
Mailing Address - Fax:302-454-6446
Practice Address - Street 1:4745 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 106
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2067
Practice Address - Country:US
Practice Address - Phone:302-454-9800
Practice Address - Fax:302-454-6446
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20007561207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1159216OtherAETNA
DEI43371OtherBLUE CROSS BLUE SHIELD
425996OtherCOVENTRY
425996OtherCOVENTRY
I43371Medicare UPIN
NJ100640QCUMedicare ID - Type UnspecifiedNJ MEDICARE