Provider Demographics
NPI:1679545172
Name:MARINO, JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:MARINO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88211-0629
Mailing Address - Country:US
Mailing Address - Phone:575-832-8282
Mailing Address - Fax:
Practice Address - Street 1:612 N 13TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1112
Practice Address - Country:US
Practice Address - Phone:575-736-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT136; ANKLE LIC 14213ES0103X
NM333213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000014881OtherBLUE CROSS BLUE SHIELD
480024176OtherMEDICARE RAILROAD
MT1679545172Medicaid
MTU68233Medicare UPIN
MT010001488Medicare PIN
480024176OtherMEDICARE RAILROAD