Provider Demographics
NPI:1285722017
Name:MARSHALL, JOY M (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:M
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13719 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3439
Mailing Address - Country:US
Mailing Address - Phone:216-307-3005
Mailing Address - Fax:
Practice Address - Street 1:13719 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3439
Practice Address - Country:US
Practice Address - Phone:216-307-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-2262M207Q00000X
OH35062262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0135651Medicaid
OH000000504232OtherANTHEM BC/BS
OHP00705956OtherRRCARE
OHH62262OtherAPEX SUMMA
OHH62262OtherAPEX SUMMA
OH000000504232OtherANTHEM BC/BS
OH0135651Medicaid
OH4200452Medicare PIN