MEDICARE: DR. V BLAKE MARSHALL JR. DO

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	207R00000X	Internal Medicine Physician	OS005994	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952341992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. V BLAKE MARSHALL JR. DO

Provider Business Mailing Address
First Line	:	2410 DELANCEY ST
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19103-6409
Country	:	US
Telephone Number	:	215-732-7178
Fax Number	:	215-725-4877

Provider Business Practice Location Address
First Line	:	2230 COTTMAN AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19149-1230
Country	:	US
Telephone Number	:	215-685-0603
Fax Number	:	215-725-4877

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/08/2007

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