Provider Demographics
NPI:1457343824
Name:MARSHALL, STEPHEN N (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:N
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:STE 221
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-631-3668
Mailing Address - Fax:315-631-3670
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:STE 221
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-631-3668
Practice Address - Fax:315-631-3670
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0022861213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00507933Medicaid
T78198Medicare UPIN
NYDD0110Medicare ID - Type Unspecified