Provider Demographics
NPI:1023100526
Name:MARSHALL, JOHN EVERETT (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:EVERETT
Last Name:MARSHALL
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 1:104 LINCOLN MEDICAL PARK
Mailing Address - Street 2:1446 GASTON ST.
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28092-4402
Mailing Address - Country:US
Mailing Address - Phone:704-735-4445
Mailing Address - Fax:704-735-4060
Practice Address - Street 1:104 LINCOLN MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-4402
Practice Address - Country:US
Practice Address - Phone:704-735-4445
Practice Address - Fax:704-735-4060
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39646207QA0505X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8954088Medicaid
NC54088OtherBLUE CROSS/BLUE SHIELD
NCD69581Medicare UPIN
NC8954088Medicaid