Provider Demographics
NPI:1174573992
Name:ORCUTT, MARSHA J (MD)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:J
Last Name:ORCUTT
Suffix:
Gender:F
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:P.O. BOX 1000, DEPT 34
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38148-0001
Mailing Address - Country:US
Mailing Address - Phone:901-383-8860
Mailing Address - Fax:901-383-8985
Practice Address - Street 1:50 HUMPHREYS CTR
Practice Address - Street 2:SUITE 23
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2369
Practice Address - Country:US
Practice Address - Phone:901-383-8860
Practice Address - Fax:901-383-8985
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350436322085R0202X
TNMD436542085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000066144OtherANTHEM
KY64000102Medicaid
IN200246580AMedicaid
OH0431134Medicaid
OH1601325OtherUHC
WV1803386000Medicaid
OH2378543OtherAETNA
WV1803386000Medicaid