Provider Demographics
NPI:1376516393
Name:MARINO, REINA ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:REINA
Middle Name:ANNE
Last Name:MARINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2130 ASH LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-2118
Mailing Address - Country:US
Mailing Address - Phone:267-259-9759
Mailing Address - Fax:
Practice Address - Street 1:2200 ARCH ST
Practice Address - Street 2:#102
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1330
Practice Address - Country:US
Practice Address - Phone:215-561-3363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-09
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057898L2085R0202X
NJ25MA069124002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G39776Medicare UPIN