Provider Demographics
NPI:1346517646
Name:RICHARD D MARINO, MD APMC
Entity Type:Organization
Organization Name:RICHARD D MARINO, MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-888-8880
Mailing Address - Street 1:4224 HOUMA BLVD
Mailing Address - Street 2:STE. 570
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2933
Mailing Address - Country:US
Mailing Address - Phone:504-888-8880
Mailing Address - Fax:504-454-5813
Practice Address - Street 1:4224 HOUMA BLVD
Practice Address - Street 2:STE. 570
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2933
Practice Address - Country:US
Practice Address - Phone:504-888-8880
Practice Address - Fax:504-454-5813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12739207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA53935OtherOLD MEDICARE #
LA1183831Medicaid
LA1183831Medicaid