Healthcare Provider Details

I. General information

NPI: 1285722017
Provider Name (Legal Business Name): JOY M MARSHALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13719 LORAIN AVE
CLEVELAND OH
44111-3439
US

IV. Provider business mailing address

13719 LORAIN AVE
CLEVELAND OH
44111-3439
US

V. Phone/Fax

Practice location:
  • Phone: 216-307-3005
  • Fax:
Mailing address:
  • Phone: 216-307-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-06-2262M
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35062262
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: