Individual
DR. MARIELLEN DENTINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
1024941
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100242750
—
IN
01
—
390004294
RAILROAD MEDICARE
IN
Enumeration date
07/28/2005
Last updated
06/17/2022
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