Provider Demographics
NPI:1073672515
Name:MARSHALL, SUSAN BETH (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:BETH
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 WEST 85TH STREET
Mailing Address - Street 2:#1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024
Mailing Address - Country:US
Mailing Address - Phone:212-222-1722
Mailing Address - Fax:888-868-9848
Practice Address - Street 1:1 WEST 85TH STREET
Practice Address - Street 2:#1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024
Practice Address - Country:US
Practice Address - Phone:212-222-1722
Practice Address - Fax:888-868-9848
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2023-08-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY184015207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01616628Medicaid
NYG20183Medicare UPIN
NY01616628Medicaid