Provider Demographics
NPI:1558355271
Name:TAMBURRINO, MARIJO B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIJO
Middle Name:B
Last Name:TAMBURRINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3355 GLENDALE AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2426
Mailing Address - Country:US
Mailing Address - Phone:419-383-7146
Mailing Address - Fax:419-383-2050
Practice Address - Street 1:3120 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5811
Practice Address - Country:US
Practice Address - Phone:419-383-5695
Practice Address - Fax:419-383-3031
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350433522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0465250Medicaid
OHTA0494612Medicare ID - Type Unspecified
A79992Medicare UPIN