Provider Demographics
NPI:1528122603
Name:MARSHALL, ERNEST W SR (MD)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:W
Last Name:MARSHALL
Suffix:SR
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 1:136 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1332
Mailing Address - Country:US
Mailing Address - Phone:502-585-5325
Mailing Address - Fax:502-585-1137
Practice Address - Street 1:136 W MARKET ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1332
Practice Address - Country:US
Practice Address - Phone:502-585-5325
Practice Address - Fax:502-585-1137
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19128174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000047197OtherANTHEM BCBS
KY1052399OtherPASSPORT
KY64191281Medicaid
KY000000047197OtherANTHEM BCBS
C71982Medicare UPIN