Healthcare Provider Details

I. General information

NPI: 1447466263
Provider Name (Legal Business Name): ERIK MARINKO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 HIGHLAND AVE
WINCHESTER MA
01890-1446
US

IV. Provider business mailing address

250 MAPLE ST
DANVERS MA
01923-1517
US

V. Phone/Fax

Practice location:
  • Phone: 781-256-7530
  • Fax:
Mailing address:
  • Phone: 978-774-9896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number815
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: