Provider Demographics
NPI:1740297282
Name:MARSHBURN, PAUL BARTOW (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:BARTOW
Last Name:MARSHBURN
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:PO BOX 601372
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1372
Mailing Address - Country:US
Mailing Address - Phone:704-355-3149
Mailing Address - Fax:704-355-5891
Practice Address - Street 1:1025 MOREHEAD MEDICAL DR
Practice Address - Street 2:SUITE 500, 5TH FLOOR
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2968
Practice Address - Country:US
Practice Address - Phone:704-355-3149
Practice Address - Fax:704-355-5891
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29621207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC54808OtherBCBS NC
NC1740297282Medicaid
NC8954808Medicaid
NC460002794Medicare PIN
NC8954808Medicaid
NCC85327Medicare UPIN
NC54808OtherBCBS NC
NC2206691AMedicare PIN