MEDICARE: BRADLEY S 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
1	2080P0202X	Pediatric Cardiology Physician	35.089739	OH
2	2080P0203X	Pediatric Critical Care Medicine Physician	35.089739	OH

Other Identifiers

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

General Provider Information

NPI Number	:	1457373284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADLEY S MARINO M.D.

Provider Business Mailing Address
First Line	:	9500 EUCLID AVE # M41
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-0002
Country	:	US
Telephone Number	:	216-313-0540
Fax Number	:	216-445-3692

Provider Business Practice Location Address
First Line	:	9500 EUCLID AVE # M41
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44195-3026
Country	:	US
Telephone Number	:	216-313-0540
Fax Number	:	216-445-3692

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	10/15/2021

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Directions to “ BRADLEY S MARINO M.D.” Practice Location

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