Individual
KEITH MARSHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5547 W MAIN ST, VERONA, NY 13478-3426
(315) 363-3482
(315) 363-1597
Mailing address
5547 W MAIN ST, VERONA, NY 13478-3426
(315) 363-3482
(315) 363-1597
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
267029
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03585751
—
NY
01
—
267029
NYS LICENSE
NY
Enumeration date
06/18/2010
Last updated
11/21/2018
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