Provider Demographics
NPI:1841253648
Name:MARSHALL, MARTYE L (MD)
Entity type:Individual
Prefix:
First Name:MARTYE
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 W CHESTER PIKE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-5657
Mailing Address - Country:US
Mailing Address - Phone:610-738-8016
Mailing Address - Fax:610-918-6316
Practice Address - Street 1:915 OLD FERN HILL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4269
Practice Address - Country:US
Practice Address - Phone:610-738-2590
Practice Address - Fax:610-918-6316
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
089282Medicare ID - Type Unspecified
D40551Medicare UPIN