Provider Demographics
NPI:1447221122
Name:MARINO, RICHARD P (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:P
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 1:733 N BEERS ST
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1528
Mailing Address - Country:US
Mailing Address - Phone:732-264-8484
Mailing Address - Fax:732-274-4324
Practice Address - Street 1:733 N BEERS ST
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1528
Practice Address - Country:US
Practice Address - Phone:732-264-8484
Practice Address - Fax:732-274-4324
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB60894207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
785693AVPMedicare ID - Type Unspecified
NJGO9493Medicare UPIN