Provider Demographics
NPI:1871597310
Name:MARSHALL, JAMES WARNER JR (DO)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WARNER
Last Name:MARSHALL
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:64 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2505
Mailing Address - Country:US
Mailing Address - Phone:203-913-2538
Mailing Address - Fax:
Practice Address - Street 1:521 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3506
Practice Address - Country:US
Practice Address - Phone:203-529-3271
Practice Address - Fax:203-529-3273
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2021-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000204207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT120000052Medicare ID - Type Unspecified
CTB37939Medicare UPIN