Provider Demographics
NPI:1194592204
Name:BAYNES-MARSH, ELIJAH GABRIEL (MAT, LAT, ATC)
Entity type:Individual
Prefix:MR
First Name:ELIJAH
Middle Name:GABRIEL
Last Name:BAYNES-MARSH
Suffix:
Gender:M
Credentials:MAT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2713 OAK AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-4225
Mailing Address - Country:US
Mailing Address - Phone:651-600-0356
Mailing Address - Fax:
Practice Address - Street 1:1 AVENUE OF THE ARTS
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3072
Practice Address - Country:US
Practice Address - Phone:651-600-0356
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01360040372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer