MEDICARE: PAUL BARTOW MARSHBURN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	29621	NC
2	207VE0102X	Reproductive Endocrinology Physician	29621	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	54808	OTHER	NC	BCBS NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740297282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BARTOW MARSHBURN MD

Provider Business Mailing Address
First Line	:	PO BOX 601372
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-1372
Country	:	US
Telephone Number	:	704-355-3149
Fax Number	:	704-355-5891

Provider Business Practice Location Address
First Line	:	1025 MOREHEAD MEDICAL DR
Second Line	:	SUITE 500, 5TH FLOOR
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2968
Country	:	US
Telephone Number	:	704-355-3149
Fax Number	:	704-355-5891

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	08/05/2022

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