Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251E1300X | Electrophysiology, Clinical | 17821-54217 | MD |
N | 2251X0800X | Physical Therapist - Orthopedic | 17821 | MD |
NPI | 1639106677 |
---|---|
Provider Name | Dr. Edward Lee Marshall JR. |
First Address | Mount Airy, MD 21771-8015 |
Second Address | Mount Airy, MD 21771-8015 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 31/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
401298400 | (05) | MD |