Provider Demographics
NPI:1144208380
Name:MARINA, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:MARINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:918 TRAILWOOD DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5037
Mailing Address - Country:US
Mailing Address - Phone:330-726-7598
Mailing Address - Fax:330-726-9357
Practice Address - Street 1:918 TRAILWOOD DR
Practice Address - Street 2:SUITE 1
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5037
Practice Address - Country:US
Practice Address - Phone:330-726-7598
Practice Address - Fax:330-726-9357
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-047481207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0639803Medicaid
OHMA0589951Medicare PIN
C03122Medicare UPIN