Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 34079 | NC |
N | 207L00000X | Anesthesiologist | 34079 | NC |
N | 207Q00000X | Family Doctor | 34079 | NC |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 34079 | NC |
N | 2081S0010X | Sports Medicine | 34079 | NC |
N | 213ES0000X | Sports Medicine | 34079 | NC |
Y | 208D00000X | General Practice Physician | 34079 | NC |
NPI | 1104070820 |
---|---|
Provider Name | Dr. Baptiste S Marino |
First Address | Matthews, NC 28106-1707 |
Second Address | Matthews, NC 28105 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2008 |
Last Update Date | 27/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8950665 | (05) | NC |