Healthcare Provider Details

I. General information

NPI: 1689723850
Provider Name (Legal Business Name): RICHARD D MARINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4224 HOUMA BLVD SUITE 140
METAIRIE LA
70006-2933
US

IV. Provider business mailing address

42 CRANE ST
NEW ORLEANS LA
70124-4309
US

V. Phone/Fax

Practice location:
  • Phone: 504-888-8880
  • Fax: 504-454-5001
Mailing address:
  • Phone: 504-220-8839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number012739
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: