Individual
DR. MARSHALL LEROY UPSHUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14139 POTOMAC MILLS ROAD, WOODBRIDGE, VA 22192-4644
(703) 490-8400
(703) 490-7635
Mailing address
KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP, 2101 E JEFFERSON ST PPQA MEDICARE COMPLAINCE UNIT 6 W, ROCKVILLE, MD 20852-4908
(301) 816-6660
(301) 816-6308
Taxonomy
Speciality
Code
Description
License number
State
152WP0200X
Pediatric Optometrist
Primary
0101037842
VA
Other
Enumeration date
12/04/2006
Last updated
07/08/2007
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