1710030044 NPI number — NATHAN ANDREW MARSH M.D.

Table of content: NATHAN ANDREW MARSH M.D. (NPI 1710030044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710030044 NPI number — NATHAN ANDREW MARSH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSH
Provider First Name:
NATHAN
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710030044
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 W HOSPITAL RD
Provider Second Line Business Mailing Address:
EISENHOWER ARMY MEDICAL CENTER, ATTN CREDENTIALS
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30905-5741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-787-2720
Provider Business Mailing Address Fax Number:
706-787-8176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1919 LATHROP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-5937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-459-3545
Provider Business Practice Location Address Fax Number:
907-328-0474
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  58800 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XX0005X , with the licence number: 240356 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 240356 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1756559 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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