Basic Information
| Provider Information | |||||||||
| NPI: | 1215321419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AHEARN | ||||||||
| FirstName: | MARSHALL | ||||||||
| MiddleName: | ALEXANDER | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 MACNIDER HALL | ||||||||
| Address2: | CB 7225 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044517314 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4420 LAKE BOONE TRL | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276077505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7044517314 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2015 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | DR.0060280 | CO | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | DR.0060280 | CO | N | Allopathic & Osteopathic Physicians | Hospitalist | 208000000X | 2019-02861 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.