Healthcare Provider Details

I. General information

NPI: 1619997566
Provider Name (Legal Business Name): JOHN O. MARSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/11/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CHERRY GROVE ROAD
MIDDLEBROOK VA
24459
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-887-2627
  • Fax: 540-886-2726
Mailing address:
  • Phone: 540-224-5715
  • Fax: 540-224-5684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101037747
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: