Healthcare Provider Details

I. General information

NPI: 1730645458
Provider Name (Legal Business Name): MARSHALL PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

322 2ND AVE
SIDNEY OH
45365-1263
US

IV. Provider business mailing address

204 PERIDOT DR
ANNA OH
45302-8632
US

V. Phone/Fax

Practice location:
  • Phone: 937-217-9393
  • Fax:
Mailing address:
  • Phone: 937-217-9393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: SARAH MARSHALL
Title or Position: OWNER
Credential: MD
Phone: 937-217-9393