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NPI Code Detail

MEDICARE: GLEN A MARINO MD

MEDICARE: GLEN A 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
1204D00000XNeuromusculoskeletal Medicine & OMM PhysicianMD046567LPA

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 : 1902804511
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLEN A MARINO MD
Provider Business Mailing Address
First Line : PO BOX 327
Second Line :
City : ORWIGSBURG
State : PA
Zip : 17961-0327
Country : US
Telephone Number : 570-621-5121
Fax Number : 570-621-9301
Provider Business Practice Location Address
First Line : 420 S JACKSON ST
Second Line :
City : POTTSVILLE
State : PA
Zip : 17901-3625
Country : US
Telephone Number : 570-621-5210
Fax Number : 570-621-9301
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2005
Last Update Date : 10/17/2007

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Directions to “ GLEN A MARINO MD” Practice Location

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