Provider Demographics
NPI:1922112523
Name:MARINO, JOHN PATRICK (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PATRICK
Last Name:MARINO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10012 KENNERLY RD
Mailing Address - Street 2:STE 301
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2197
Mailing Address - Country:US
Mailing Address - Phone:314-842-5670
Mailing Address - Fax:314-842-2889
Practice Address - Street 1:10012 KENNERLY RD
Practice Address - Street 2:STE 301
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2197
Practice Address - Country:US
Practice Address - Phone:314-842-5670
Practice Address - Fax:314-842-2889
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2019-03-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR2C27207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine