Provider Demographics
NPI:1639106677
Name:MARSHALL, EDWARD LEE JR (DPT, ECS, OCS, RNCS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEE
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:DPT, ECS, OCS, RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:6091 TOURSOME DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-8015
Mailing Address - Country:US
Mailing Address - Phone:301-252-5380
Mailing Address - Fax:301-829-3211
Practice Address - Street 1:6091 TOURSOME DR
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-8015
Practice Address - Country:US
Practice Address - Phone:301-252-5380
Practice Address - Fax:301-829-3211
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17821-542172251E1300X
MD178212251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401298400Medicaid
MD490483Medicare PIN