Provider Demographics
NPI:1245255991
Name:MARINO, JAMES JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:MARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13840 US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3296
Mailing Address - Country:US
Mailing Address - Phone:772-589-2992
Mailing Address - Fax:772-581-8331
Practice Address - Street 1:13840 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3296
Practice Address - Country:US
Practice Address - Phone:772-589-2992
Practice Address - Fax:772-581-8331
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0068777207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27368OtherBCBS FL
FLE97233Medicare UPIN
FL27368WMedicare PIN