Provider Demographics
NPI:1952928574
Name:MARSHALL, CALLIE (MD)
Entity type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:
Other - Last Name:HARAKAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:WUSM PEDS, 1 CHILDENS PL, MSC 8116-0043-08
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1002
Mailing Address - Country:US
Mailing Address - Phone:314-454-4826
Mailing Address - Fax:314-454-6633
Practice Address - Street 1:WUSM PEDS, 1 CHILDRENS PL, MSC 8116-0043-08
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-4826
Practice Address - Fax:314-454-4633
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021029009208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics