Provider Demographics
NPI:1962445072
Name:MARINO, JOSEPH FREDERICK (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:FREDERICK
Last Name:MARINO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 STERLING SILVER BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5642
Mailing Address - Country:US
Mailing Address - Phone:386-917-7480
Mailing Address - Fax:386-917-7476
Practice Address - Street 1:1745 STERLING SILVER BLVD
Practice Address - Street 2:STE 104
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-5642
Practice Address - Country:US
Practice Address - Phone:386-917-7480
Practice Address - Fax:386-917-7476
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB02940200207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3410803Medicaid
NJ3410803Medicaid
454791Medicare ID - Type Unspecified