MEDICARE: DR. KRISTOPHER MARIN D.O.

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	208100000X	Physical Medicine & Rehabilitation Physician	34.012663	OH
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	34.012663	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

General Provider Information

NPI Number	:	1528472263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTOPHER MARIN D.O.

Provider Business Mailing Address
First Line	:	840 NW WASHINGTON BLVD STE A
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-6381
Country	:	US
Telephone Number	:	513-867-5770
Fax Number	:	513-737-2468

Provider Business Practice Location Address
First Line	:	840 NW WASHINGTON BLVD STE A
Second Line	:
City	:	HAMILTON
State	:	OH
Zip	:	45013-6381
Country	:	US
Telephone Number	:	513-867-5770
Fax Number	:	513-737-2468

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

Provider Enumeration Date	:	06/19/2014
Last Update Date	:	01/14/2021

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