Healthcare Provider Details

I. General information

NPI: 1912901273
Provider Name (Legal Business Name): JOSEPH KENNETH MARSHALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2921 11TH ST S
ARLINGTON VA
22204-0827
US

IV. Provider business mailing address

1921 FRANKLIN AVE
MC LEAN VA
22101-5309
US

V. Phone/Fax

Practice location:
  • Phone: 703-979-1425
  • Fax:
Mailing address:
  • Phone: 703-533-8004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101026481
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: