=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740297282
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAUL BARTOW MARSHBURN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2006
-----------------------------------------------------
Last Update Date | 08/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 MOREHEAD MEDICAL DR SUITE 500, 5TH FLOOR
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28204-2968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-355-3149
-----------------------------------------------------
Fax | 704-355-5891
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 601372
-----------------------------------------------------
City | CHARLOTTE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28260-1372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-355-3149
-----------------------------------------------------
Fax | 704-355-5891
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 29621
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VE0102X
-----------------------------------------------------
Taxonomy Name | Reproductive Endocrinology Physician
-----------------------------------------------------
License Number | 29621
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------