Provider Demographics
NPI:1790865970
Name:MARINARO, ROBERT EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EDWARD
Last Name:MARINARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5971 VIRGINIA PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5539
Mailing Address - Country:US
Mailing Address - Phone:972-542-4646
Mailing Address - Fax:972-542-0909
Practice Address - Street 1:5971 VIRGINIA PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5539
Practice Address - Country:US
Practice Address - Phone:972-542-4646
Practice Address - Fax:972-542-0909
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3388207N00000X
NJ25MA04790600207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A5519Medicare PIN
NJ504607Medicare ID - Type Unspecified