Healthcare Provider Details

I. General information

NPI: 1801814413
Provider Name (Legal Business Name): RICHARD J MARSDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BROADWAY N
FARGO ND
58102-3641
US

IV. Provider business mailing address

801 BROADWAY N
FARGO ND
58102-3641
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-5015
  • Fax: 701-234-7481
Mailing address:
  • Phone: 701-234-5015
  • Fax: 701-234-7481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number3729
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number26345
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: