Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 6590 | MD |
NPI | 1205051034 |
---|---|
Provider Name | Dr. Raymond Collins Marshall |
First Address | Silver Spring, MD 20904-1234 |
Second Address | Lanham, MD 20706-3025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |