Provider Demographics
NPI:1003462797
Name:MARINO, LUCYNDIA ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCYNDIA
Middle Name:ROSE
Last Name:MARINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CLASSIC LN
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-5304
Mailing Address - Country:US
Mailing Address - Phone:724-654-1461
Mailing Address - Fax:
Practice Address - Street 1:130 CLASSIC LN
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-5304
Practice Address - Country:US
Practice Address - Phone:724-654-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD070499L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD070499LOtherACTIVE RETIRED LICENSE