Provider Demographics
NPI:1093000390
Name:MARINO, EVAN FRANK (DO)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:FRANK
Last Name:MARINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5044
Mailing Address - Country:US
Mailing Address - Phone:603-548-5969
Mailing Address - Fax:
Practice Address - Street 1:99 JACKSON ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-689-2540
Practice Address - Fax:978-689-2540
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274837207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology