Provider Demographics
NPI:1871512350
Name:MARSHALL, COURTNEY
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 PRIEST BRIDGE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2429
Mailing Address - Country:US
Mailing Address - Phone:410-451-3000
Mailing Address - Fax:410-630-7625
Practice Address - Street 1:2124 PRIEST BRIDGE DR STE 10
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2429
Practice Address - Country:US
Practice Address - Phone:410-451-3000
Practice Address - Fax:410-630-7625
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR163464176B00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQ08283Medicare UPIN
MD403986600Medicare ID - Type Unspecified