Provider Demographics
NPI:1255518296
Name:MARINO, CAROL (DO)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 OLD BANK RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2416
Mailing Address - Country:US
Mailing Address - Phone:513-248-0100
Mailing Address - Fax:513-248-4334
Practice Address - Street 1:201 OLD BANK RD
Practice Address - Street 2:SUITE 103
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2416
Practice Address - Country:US
Practice Address - Phone:513-248-0100
Practice Address - Fax:513-248-4334
Is Sole Proprietor?:No
Enumeration Date:2008-01-22
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH269605Medicaid
OHG21939Medicare UPIN
OH0796615Medicare PIN