=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518120898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY F. MARINO, M.D., P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2008
-----------------------------------------------------
Last Update Date | 07/07/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 99 JACKSON ST
-----------------------------------------------------
City | METHUEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01844-5044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-689-2540
-----------------------------------------------------
Fax | 978-682-6667
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 99 JACKSON ST
-----------------------------------------------------
City | METHUEN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01844-5044
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-689-2540
-----------------------------------------------------
Fax | 978-682-6667
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ANTHONY F. MARINO
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 978-689-2540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 46674
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------