Provider Demographics
NPI:1093791691
Name:MARINO, VINCENT (DO)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
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 1:107 ROYAL BIRKDALE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIANA
Mailing Address - State:OH
Mailing Address - Zip Code:44408-8493
Mailing Address - Country:US
Mailing Address - Phone:330-482-9350
Mailing Address - Fax:330-482-5695
Practice Address - Street 1:107 ROYAL BIRKDALE DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIANA
Practice Address - State:OH
Practice Address - Zip Code:44408-8493
Practice Address - Country:US
Practice Address - Phone:330-482-9350
Practice Address - Fax:330-482-5695
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007842207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid
OHPENDINGMedicaid
OHPENDINGMedicare ID - Type Unspecified