Provider Demographics
NPI:1265610604
Name:PHILIP A. MARINO, M.D., P.C.
Entity type:Organization
Organization Name:PHILIP A. MARINO, M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:423-638-5988
Mailing Address - Street 1:PO BOX 52047
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2047
Mailing Address - Country:US
Mailing Address - Phone:800-343-2599
Mailing Address - Fax:865-531-2722
Practice Address - Street 1:8870 CEDAR SPRINGS LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5407
Practice Address - Country:US
Practice Address - Phone:800-343-2599
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DH0149OtherRAILROAD MEDICARE
TN38183292Medicaid
KY7100045620Medicaid
KY7100045620Medicaid