Provider Demographics
NPI:1669521076
Name:MARSHALL, GINDER (MD)
Entity type:Individual
Prefix:DR
First Name:GINDER
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-1930
Mailing Address - Country:US
Mailing Address - Phone:310-673-8372
Mailing Address - Fax:310-673-3270
Practice Address - Street 1:655 E QUEEN ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-1930
Practice Address - Country:US
Practice Address - Phone:310-673-8372
Practice Address - Fax:310-673-3270
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58889207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG58889Medicare ID - Type UnspecifiedPPIN
CAWG58889AMedicare ID - Type UnspecifiedAPC RENDERING PROVIDER #
CAF41925Medicare UPIN