Provider Demographics
NPI:1942226774
Name:MARINE, JEAN MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:MARINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 NORTHWINDS PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30009-2232
Mailing Address - Country:US
Mailing Address - Phone:800-930-0748
Mailing Address - Fax:
Practice Address - Street 1:4 GLEN COVE DR STE 206
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-4239
Practice Address - Country:US
Practice Address - Phone:207-301-5454
Practice Address - Fax:207-301-5353
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14996207X00000X
VA0101049589207X00000X
KY34764207X00000X
WAMD00042252207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA340447OtherLABOR & INDUSTRIES
VA421768OtherSOUTHERN HEALTH
VA010048257Medicaid
VA102046OtherANTHEM
KY64992043Medicaid
WA2044122Medicaid
VAP00139020OtherRAILROAD MEDICARE
VA102046OtherANTHEM