Provider Demographics
NPI:1255838819
Name:MARINO, JESSICA (MD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MARINO
Suffix:
Gender:F
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:32 STRAWBERRY HILL COURT
Mailing Address - Street 2:4TH FL, STE 6
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2594
Mailing Address - Country:US
Mailing Address - Phone:203-977-2566
Mailing Address - Fax:203-276-2568
Practice Address - Street 1:32 STRAWBERRY HILL COURT
Practice Address - Street 2:4TH FL, STE 6
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2594
Practice Address - Country:US
Practice Address - Phone:203-977-2566
Practice Address - Fax:203-276-2568
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2021-08-05
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Provider Licenses
StateLicense IDTaxonomies
CT68737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine