Provider Demographics
NPI:1508386376
Name:MARINO, MARK THOMAS
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:MARINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7508 CIRCULO SEQUOIA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8468
Mailing Address - Country:US
Mailing Address - Phone:914-513-6459
Mailing Address - Fax:
Practice Address - Street 1:7508 CIRCULO SEQUOIA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8468
Practice Address - Country:US
Practice Address - Phone:914-513-6459
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08070300207R00000X
CAG152698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine