Provider Demographics
NPI:1396702858
Name:MENDENHALL, MARSHALL CORNELL (MD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:CORNELL
Last Name:MENDENHALL
Suffix:
Gender:M
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:UNIT 21414 BOX 192
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09705-7101
Mailing Address - Country:US
Mailing Address - Phone:011326-544-5859
Mailing Address - Fax:
Practice Address - Street 1:UNIT 21414 BOX 192
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09705-7101
Practice Address - Country:US
Practice Address - Phone:011326-544-5859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051826A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine