Provider Demographics
NPI:1861549214
Name:MARINO, JOSEPH V (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:V
Last Name:MARINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:20 MEDICAL CENTER DR
Mailing Address - Street 2:STE 200
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35501-3425
Mailing Address - Country:US
Mailing Address - Phone:205-544-2195
Mailing Address - Fax:844-206-1763
Practice Address - Street 1:20 MEDICAL CENTER DR
Practice Address - Street 2:STE 200
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-3425
Practice Address - Country:US
Practice Address - Phone:205-544-2195
Practice Address - Fax:844-206-1763
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2017-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY153683207Q00000X
AL29084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC3871Medicare UPIN
NYRA7409Medicare ID - Type Unspecified
NY00761642Medicare ID - Type Unspecified