Healthcare Provider Details

I. General information

NPI: 1225295413
Provider Name (Legal Business Name): PHILLIP MARSHALL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7107 JAHNKE RD
RICHMOND VA
23225-4017
US

IV. Provider business mailing address

541 RALEIGH MANOR RD
HENRICO VA
23229-7173
US

V. Phone/Fax

Practice location:
  • Phone: 804-323-8282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0067530
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101248744
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: