Provider Demographics
NPI:1174546261
Name:JOSEPH T. MARINO, M.D., INC.
Entity type:Organization
Organization Name:JOSEPH T. MARINO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:916-962-3112
Mailing Address - Street 1:6660 COYLE AVENUE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0303
Mailing Address - Country:US
Mailing Address - Phone:916-962-3112
Mailing Address - Fax:916-962-1536
Practice Address - Street 1:6660 COYLE AVENUE
Practice Address - Street 2:SUITE 330
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0303
Practice Address - Country:US
Practice Address - Phone:916-962-3112
Practice Address - Fax:916-962-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG387422080P0214X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G387420Medicaid
CA00G387420Medicaid
A47579Medicare UPIN