Provider Demographics
NPI:1306979091
Name:MARSHALL, LONNIE L (D O)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:L
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:D O
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11071 BABCOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8929
Mailing Address - Country:US
Mailing Address - Phone:724-625-5401
Mailing Address - Fax:
Practice Address - Street 1:120 5TH AVE
Practice Address - Street 2:P 4511
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-3000
Practice Address - Country:US
Practice Address - Phone:412-544-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004268L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
C31032Medicare UPIN