Provider Demographics
NPI:1528377744
Name:VINCENT P MARINO MD PA
Entity Type:Organization
Organization Name:VINCENT P MARINO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:321-868-7170
Mailing Address - Street 1:333 W COCOA BEACH CSWY
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3513
Mailing Address - Country:US
Mailing Address - Phone:321-868-7170
Mailing Address - Fax:
Practice Address - Street 1:333 W COCOA BEACH CSWY
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3513
Practice Address - Country:US
Practice Address - Phone:321-868-7170
Practice Address - Fax:321-868-7159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME42959261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58951Medicare UPIN
FL79849Medicare PIN