MEDICARE: MICHAEL MARSH M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	R3140	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1710243027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL MARSH M.D., PH.D.

Provider Business Mailing Address
First Line	:	4114 POND HILL RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1273
Country	:	US
Telephone Number	:	210-761-5448
Fax Number	:

Provider Business Practice Location Address
First Line	:	4114 POND HILL RD STE 102
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78231-1273
Country	:	US
Telephone Number	:	210-761-5448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2012
Last Update Date	:	07/15/2021

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