Individual
MARINO D TAVAREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.,
Contact information
Practice address
12 LEACH RD, LYONS HEALTH CENTER, LYONS, NY 14489-9732
(315) 946-6075
(315) 946-4254
Mailing address
12 LEACH RD, LYONS HEALTH CENTER, LYONS, NY 14489-9732
(315) 946-6075
(315) 946-4254
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
12860
HI
207Q00000X
Family Medicine Physician
Primary
232852
NY
207Q00000X
Family Medicine Physician
MD441558
PA
2083P0901X
Public Health & General Preventive Medicine Physician
12860
HI
2083P0901X
Public Health & General Preventive Medicine Physician
232852
NY
2083P0901X
Public Health & General Preventive Medicine Physician
MD441558
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02868248
—
NY
Enumeration date
10/19/2006
Last updated
01/05/2015
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