Basic Information
| Provider Information | |||||||||
| NPI: | 1528034865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARSHALL | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 COX RD | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230609263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8049685700 | ||||||||
| FaxNumber: | 8042850088 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 POTOMAC STATION DR NE | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201761816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038401396 | ||||||||
| FaxNumber: | 8043787728 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 11/19/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME141661 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101247204 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 83392 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 52860 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 63817 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 312663 | LA | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 02543039 | 05 | NY | MEDICAID |