Provider Demographics
NPI:1275645376
Name:MARSHALL, TIMOTHY LEROY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:LEROY
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:L
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PC
Mailing Address - Street 1:48 NEWMARKET SQ
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-2721
Mailing Address - Country:US
Mailing Address - Phone:757-825-8030
Mailing Address - Fax:757-847-9149
Practice Address - Street 1:48 NEWMARKET SQ
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-2721
Practice Address - Country:US
Practice Address - Phone:757-825-8030
Practice Address - Fax:757-847-9149
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029169207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA22678597OtherTRICARE
VA007284OtherBLUE CROSS/BLUE SHEILD
VA12873OtherOPTIMA
VA6059279Medicaid
VA266683OtherMDIPA
VAC47587Medicare UPIN
VA6059279Medicaid