Provider Demographics
NPI:1427140391
Name:BALISH, MARSHALL SAMUEL (MD-PHD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:SAMUEL
Last Name:BALISH
Suffix:
Gender:M
Credentials:MD-PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11902 RENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4343
Mailing Address - Country:US
Mailing Address - Phone:202-745-8144
Mailing Address - Fax:202-745-8231
Practice Address - Street 1:WASHINGTON VA MEDICAL CTR
Practice Address - Street 2:50 IRVING ST.
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20422-0001
Practice Address - Country:US
Practice Address - Phone:202-745-8144
Practice Address - Fax:202-745-8231
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC192762084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0452770Medicaid
MD77472Medicaid
DCBA688622Medicare ID - Type UnspecifiedDC MEDICARE PROVIDER NO
DCF01480Medicare UPIN