Healthcare Provider Details

I. General information

NPI: 1740297282
Provider Name (Legal Business Name): PAUL BARTOW MARSHBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MOREHEAD MEDICAL DR SUITE 500, 5TH FLOOR
CHARLOTTE NC
28204-2968
US

IV. Provider business mailing address

PO BOX 601372
CHARLOTTE NC
28260-1372
US

V. Phone/Fax

Practice location:
  • Phone: 704-355-3149
  • Fax: 704-355-5891
Mailing address:
  • Phone: 704-355-3149
  • Fax: 704-355-5891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number29621
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number29621
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: