Provider Demographics
NPI:1295794287
Name:MARINO, JOSEPH MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:MARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 LINDEN OAKS
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2839
Mailing Address - Country:US
Mailing Address - Phone:585-249-1340
Mailing Address - Fax:585-349-1349
Practice Address - Street 1:220 LINDEN OAKS
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2839
Practice Address - Country:US
Practice Address - Phone:585-249-1340
Practice Address - Fax:585-249-1349
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125606207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00464475Medicaid
NY100732BJOtherPREFERREDCARE PROVIDER
NY6739OtherBLUECROSSBLUESHIELD
NY7512314OtherAETNA
NYPO10125606OtherBLUE CHOICE PROVIDER
NYPO10125606OtherBLUE CHOICE PROVIDER
NY100732BJOtherPREFERREDCARE PROVIDER
NYDO6195Medicare UPIN