Healthcare Provider Details

I. General information

NPI: 1003462797
Provider Name (Legal Business Name): LUCYNDIA ROSE MARINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 08/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CLASSIC LN
NEW CASTLE PA
16105-5304
US

IV. Provider business mailing address

130 CLASSIC LN
NEW CASTLE PA
16105-5304
US

V. Phone/Fax

Practice location:
  • Phone: 724-654-1461
  • Fax:
Mailing address:
  • Phone: 724-654-1461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD070499L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: