Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | MD16511 | ME |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | MD16511 | ME |
NPI | 1285665828 |
---|---|
Provider Name | Richard T Marino JR. |
First Address | Portland, ME 04103-1073 |
Second Address | Portland, ME 04102-3344 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I10080 | (02) |