Individual
ANDREW MARINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 SOUTH ST, SOUTHBRIDGE, MA 01550-4051
(508) 765-9771
(508) 764-2448
Mailing address
100 SOUTH ST, SOUTHBRIDGE, MA 01550-4051
(508) 765-9771
(508) 764-2448
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
236789
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002266201
MEDICARE PTAN
MA
Enumeration date
06/11/2008
Last updated
12/01/2011
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