Healthcare Provider Details

I. General information

NPI: 1093748840
Provider Name (Legal Business Name): THOMAS FRANCIS MARINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE RD
POMPANO BEACH FL
33064-3502
US

IV. Provider business mailing address

2000 W COMMERCIAL BLVD STE 115
FT LAUDERDALE FL
33309-3060
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-6450
  • Fax:
Mailing address:
  • Phone: 954-839-8080
  • Fax: 954-839-8081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME96061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: