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General NPI Number Information
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NPI Number | 1275948648
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Entity Type | Individual
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Provider Name | RYAN MARINO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 11100 EUCLID AVE
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City | CLEVELAND
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State | OH
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Zip | 44106-1716
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Country | US
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Telephone | 216-844-1636
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Fax |
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Provider Business Mailing Address
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Address Line | 8055 MAYFIELD RD STE 105
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City | CHESTERLAND
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State | OH
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Zip | 44026-2447
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD459075
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MT205900
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35.136351
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License Number State | OH
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