MEDICARE: DR. BENTON ROBERT MARINO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	MD.205530	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023209624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENTON ROBERT MARINO M.D.

Provider Business Mailing Address
First Line	:	6517 SPANISH FORT BLVD
Second Line	:
City	:	NEW OLREANS
State	:	LA
Zip	:	70124-2429
Country	:	US
Telephone Number	:	504-283-7306
Fax Number	:

Provider Business Practice Location Address
First Line	:	6517 SPANISH FORT BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-4321
Country	:	US
Telephone Number	:	504-283-7306
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	01/11/2022

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