Provider Demographics
NPI:1841228947
Name:MARSHALL, ERIC CORNELIUS (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CORNELIUS
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1160 VARNUM ST NE STE 117
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2106
Mailing Address - Country:US
Mailing Address - Phone:202-607-5298
Mailing Address - Fax:202-330-5356
Practice Address - Street 1:1160 VARNUM ST NE
Practice Address - Street 2:SUITE 117
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017
Practice Address - Country:US
Practice Address - Phone:202-832-7007
Practice Address - Fax:240-425-4636
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101263962207Q00000X
WV29364207Q00000X
MO2018032594207Q00000X
MA277082207Q00000X
MDM49221207Q00000X
IN01079991B207Q00000X
MI5135091205207Q00000X
AK133474207Q00000X
FLME133323207Q00000X
DCCS0112180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC033890700Medicaid
MD69230200Medicaid
2185209OtherUNITED HEALTHCARE
3873549-001OtherCIGNA
19665OtherJOHNS HOPKINS HEALTHCARE LLC EHP
246302OtherANTHEM JOHNSON AVENUE
DC2680223-7710244OtherAETNA US HEALTHCARE
94133OtherAMERIGROUP (ANTHEM)
KP29GEOtherCAREFIRST
AK1700801Medicaid
246299OtherANTHEM VARNUM STREET