Healthcare Provider Details

I. General information

NPI: 1790084515
Provider Name (Legal Business Name): ROBERT FRANK MARINO MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2011
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 BEE RIDGE RD
COLUMBIA SC
29223-6802
US

IV. Provider business mailing address

2213 BEE RIDGE RD
COLUMBIA SC
29223-6802
US

V. Phone/Fax

Practice location:
  • Phone: 803-736-6036
  • Fax:
Mailing address:
  • Phone: 803-736-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number12633
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: