MEDICARE: JOHN C MARINO MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	176316	NY

General Provider Information

NPI Number	:	1831105899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN C MARINO MD

Provider Business Mailing Address
First Line	:	3200 WEST ST STE 500
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1722
Country	:	US
Telephone Number	:	585-905-0061
Fax Number	:	585-412-6612

Provider Business Practice Location Address
First Line	:	3200 WEST ST STE 500
Second Line	:
City	:	CANANDAIGUA
State	:	NY
Zip	:	14424-1722
Country	:	US
Telephone Number	:	585-905-0061
Fax Number	:	585-412-6612

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

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	12/23/2024

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