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NPI Code Detail

MEDICARE: DR. CHRIS J MARINO M.D.

MEDICARE: DR. CHRIS J MARINO M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology PhysicianME0069258FL
22084N0600XClinical Neurophysiology PhysicianME0069258FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417950635
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHRIS J MARINO M.D.
Provider Business Mailing Address
First Line : 12670 WHITEHALL DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-3619
Country : US
Telephone Number : 239-936-3554
Fax Number : 239-936-8993
Provider Business Practice Location Address
First Line : 12670 WHITEHALL DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-3619
Country : US
Telephone Number : 239-936-3554
Fax Number : 239-936-8993
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 05/30/2014

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