Healthcare Provider Details

I. General information

NPI: 1841228947
Provider Name (Legal Business Name): ERIC CORNELIUS MARSHALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE SUITE 117
WASHINGTON DC
20017
US

IV. Provider business mailing address

1160 VARNUM ST NE STE 117
WASHINGTON DC
20017-2106
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-7007
  • Fax: 240-425-4636
Mailing address:
  • Phone: 202-607-5298
  • Fax: 202-330-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101263962
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29364
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018032594
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number277082
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM49221
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01079991B
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5135091205
License Number StateMI
# 8
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number133474
License Number StateAK
# 9
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME133323
License Number StateFL
# 10
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCS0112180
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: