Provider Demographics
NPI:1144274275
Name:MARSHALL, DON A JR (MD)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:A
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 E STATE BLVD
Mailing Address - Street 2:SUTIE 100
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-4700
Mailing Address - Country:US
Mailing Address - Phone:260-471-0632
Mailing Address - Fax:260-471-3451
Practice Address - Street 1:3010 E STATE BLVD
Practice Address - Street 2:SUTIE 100
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-4700
Practice Address - Country:US
Practice Address - Phone:260-471-0632
Practice Address - Fax:260-471-3451
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038606A2084P0800X, 2084P0802X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100082250BMedicaid
IN93110OtherANTHEM HIP
IN10082250BOtherPCCM
IN119094OtherCOMPSYCH
IN000000006472OtherMPLAN & 3 RIVERS
IN000000093110OtherANTHEM BCBS
OH0944554Medicaid
IN3382OtherPHP
IN063909OtherVALUE OPT
IN01008583OtherHEALTHPLUS
IN01652800OtherMEGELLAN
IN000000006472OtherMPLAN & 3 RIVERS
IN000000093110OtherANTHEM BCBS