Provider Demographics
NPI:1023059581
Name:MARINO, BRENDA L (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:L
Last Name:MARINO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 4214
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061
Mailing Address - Country:US
Mailing Address - Phone:770-427-4800
Mailing Address - Fax:770-427-3653
Practice Address - Street 1:677 CHURCH ST
Practice Address - Street 2:HOSPITAL BASED ONLY KENNESTONE WELLSTAR
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-779-3603
Practice Address - Fax:770-793-9925
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0163922080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00088646BMedicaid