1841228947 NPI number — DR. ERIC CORNELIUS MARSHALL MD

Table of content: DR. ERIC CORNELIUS MARSHALL MD (NPI 1841228947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841228947 NPI number — DR. ERIC CORNELIUS MARSHALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARSHALL
Provider First Name:
ERIC
Provider Middle Name:
CORNELIUS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1841228947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 RHODE ISLAND AVE NW APT 203
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20001-1064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-607-5298
Provider Business Mailing Address Fax Number:
202-330-5356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1160 VARNUM ST NE
Provider Second Line Business Practice Location Address:
SUITE 117
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-832-7007
Provider Business Practice Location Address Fax Number:
240-425-4636
Provider Enumeration Date:
06/28/2006

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: 207Q00000X , with the licence number:  0101263962 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 29364 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 2018032594 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 277082 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: M49221 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 01079991B , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 5135091205 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 133474 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: CS0112180 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2185209 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 033890700 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2680223-7710244 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 3873549-001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 246302 . This is a "ANTHEM JOHNSON AVENUE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19665 . This is a "JOHNS HOPKINS HEALTHCARE LLC EHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: KP29GE . This is a "CAREFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1700801 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 69230200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 246299 . This is a "ANTHEM VARNUM STREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 94133 . This is a "AMERIGROUP (ANTHEM)" identifier . This identifiers is of the category "OTHER".




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