Provider Demographics
NPI:1245213891
Name:MARSHALL, EDWIN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:
Last Name:MARSHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 ARSENAL ST STE 10A
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2223
Mailing Address - Country:US
Mailing Address - Phone:315-425-8240
Mailing Address - Fax:315-425-8239
Practice Address - Street 1:1222 ARSENAL ST STE 10A
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2223
Practice Address - Country:US
Practice Address - Phone:315-425-8240
Practice Address - Fax:315-425-8239
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8326207R00000X, 207RC0000X
NY280813207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E08572Medicare UPIN
0029386Medicare ID - Type Unspecified