Edward Albert Marshall Jr., ATC, LAT
Individual provider Active NPI Sports Medicine (Physical Medicine & Rehabilitation) Physician · Wingate, NC
NPI 1275188484 · NPPES record last updated Sep 17, 2020
Key facts
- NPI
- 1275188484
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician 2081S0010X
- License
- LAT-4304 (NC)
- Practice address
- 224 East Wilson Street
Wingate, NC 28174 - Phone
- (704) 233-8165
- NPI assigned
- Aug 5, 2019
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LAT-4304 | NC | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | LAT-4304 | NC | Yes |
Addresses
Primary practice location
224 East Wilson Street
Wingate, NC 28174
Mailing address
3001 Alice Flagg LN Apt 207
Indian Trail, NC 28079-8415
Phone (757) 642-8949
Other providers in Wingate, NC
- Daniel Christopher Lane
- Danielle Nicole Lapergola
- Gregory Jordan Lee
- Noah Macniven
- Alex Maginnis
- Sherrie P McCaskill
- Delaney McCullough
- Shannon H McDonough
- Morgan McMahon
- Modlin & Londry V DDS PLLC
All providers in Wingate, NC · Sports Medicine (Physical Medicine & Rehabilitation) Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 17, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.