Provider Demographics
NPI:1770562324
Name:MARSHALL, RICHARD E (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
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 1:165 DARTMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5123
Mailing Address - Country:US
Mailing Address - Phone:617-859-5470
Mailing Address - Fax:617-859-5059
Practice Address - Street 1:165 DARTMOUTH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5123
Practice Address - Country:US
Practice Address - Phone:617-859-5470
Practice Address - Fax:617-859-5059
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA36833208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA036833OtherTUFTS
MA2019299Medicaid
MA0015146OtherNEIGHBORHOOD HEALTH
MAPP358OtherHARVARD PILGRIM
MAE05066OtherBLUE CROSS
MAG66347Medicare UPIN
MA036833OtherTUFTS