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General NPI Number Information
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NPI Number | 1285635508
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Entity Type | Individual
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Provider Name | JOAN GRODE MARSHAK M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 02/03/2012
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Provider Practice Location Address
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Address Line | 4600 AMBASSADOR CAFFERY PKWY
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City | LAFAYETTE
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State | LA
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Zip | 70508-6902
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Country | US
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Telephone | 337-521-9113
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Fax | 337-261-2697
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Provider Business Mailing Address
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Address Line | 4600 AMBASSADOR CAFFERY PKWY
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City | LAFAYETTE
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State | LA
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Zip | 70508-6902
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Country | US
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Telephone | 337-521-9113
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZN0500X
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Taxonomy Name | Neuropathology Physician
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License Number | 06781R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 06781R
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License Number State | LA
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