Healthcare Provider Details

I. General information

NPI: 1487622239
Provider Name (Legal Business Name): SPYRIDON I MARINIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E BRADY ST STE 100
BUTLER PA
16001-4651
US

IV. Provider business mailing address

901 E BRADY ST STE 100
BUTLER PA
16001-4651
US

V. Phone/Fax

Practice location:
  • Phone: 724-285-9200
  • Fax: 724-285-9288
Mailing address:
  • Phone: 724-285-9200
  • Fax: 724-285-9288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD447961
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD447961
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberC55834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: