Healthcare Provider Details

I. General information

NPI: 1215103270
Provider Name (Legal Business Name): LAURA M MARINARO RD. ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CAMDEN AVE
SALISBURY MD
21801-6837
US

IV. Provider business mailing address

1101 CAMDEN AVE
SALISBURY MD
21801-6837
US

V. Phone/Fax

Practice location:
  • Phone: 443-838-9223
  • Fax:
Mailing address:
  • Phone: 443-838-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberJ3-0000318
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA0000083
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code133VN1501X
TaxonomySports Dietetics Nutrition Registered Dietitian
License NumberDX3854
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: