Provider Demographics
NPI:1497861314
Name:MARINO, MARK JUDE (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JUDE
Last Name:MARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1111 MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE S-450
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-3151
Mailing Address - Country:US
Mailing Address - Phone:504-349-6423
Mailing Address - Fax:504-349-6062
Practice Address - Street 1:4228 HOUMA BLVD
Practice Address - Street 2:SUITE 520
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-3000
Practice Address - Country:US
Practice Address - Phone:504-456-8020
Practice Address - Fax:504-456-8021
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2013-11-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA024818207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1576026Medicaid
LA1576026Medicaid
4F256Medicare ID - Type Unspecified