Healthcare Provider Details

I. General information

NPI: 1679264295
Provider Name (Legal Business Name): MEGAN MARINO, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MISSION ST STE B-10
SAN FRANCISCO CA
94103-3052
US

IV. Provider business mailing address

348 W 57TH ST STE 180
NEW YORK NY
10019-3702
US

V. Phone/Fax

Practice location:
  • Phone: 203-350-2116
  • Fax: 866-326-5428
Mailing address:
  • Phone: 203-350-2116
  • Fax: 866-326-5428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MEGAN MARINO
Title or Position: OWNER
Credential: MD
Phone: 203-350-2116