Provider Demographics
NPI:1215299573
Name:MARSH, MATTHEW D (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:MARSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14690 SPRING HILL DR
Mailing Address - Street 2:STE 305
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-8102
Mailing Address - Country:US
Mailing Address - Phone:352-277-5348
Mailing Address - Fax:352-606-2857
Practice Address - Street 1:14555 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6003
Practice Address - Country:US
Practice Address - Phone:352-556-4823
Practice Address - Fax:352-556-4824
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2020-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMT200843207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015409400Medicaid
FLIG495XMedicare PIN
FL015409400Medicaid
FLIG495YMedicare PIN