Provider Demographics
NPI:1285610568
Name:MARSHALL, ANGELA MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELLE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4300 CLAGETT PINE WAY
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20782-1100
Mailing Address - Country:US
Mailing Address - Phone:301-699-5322
Mailing Address - Fax:
Practice Address - Street 1:2101 MEDICAL PARK DR
Practice Address - Street 2:SUITE 300E
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4053
Practice Address - Country:US
Practice Address - Phone:301-754-2222
Practice Address - Fax:301-754-2011
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD215911207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKP70D650Medicare ID - Type Unspecified
MDG02810C01Medicare PIN
MDH62204Medicare UPIN