Provider Demographics
NPI:1295902062
Name:COLBURN, MARION JOYCE (MD, MPH)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:JOYCE
Last Name:COLBURN
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2574 MISTY RIDGE CV
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-6828
Mailing Address - Country:US
Mailing Address - Phone:804-307-9235
Mailing Address - Fax:
Practice Address - Street 1:1 MED CENTER DR.
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506
Practice Address - Country:US
Practice Address - Phone:304-293-2436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067038207P00000X
MDD67038208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV26720OtherSTATE MEDICAL LICENSE
WY7995AOtherSTATE MEDICAL LICENSE