Marino, Glen A

Marino, Glen A is an sole proprietor health care provider with primary practice located at 420 S Jackson St , Pottsville PA 17901-3625. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM, which is considered as his primary health care specialty. Marino, Glen A can be contacted via phone (570) 621-5210.

Contact Information

Primary practice address
420 S Jackson St Pottsville PA 17901-3625
Phone: (570) 621-5210
Fax: (570) 621-9301
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Neuromusculoskeletal Medicine & OMM 204D00000X MD046567L Pennsylvania

Profile Details

NPI number 1902804511
LBN Legal business name Marino, Glen A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Jul 8th, 2005
Last updated Oct 17th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902804511 NPPES
Pennsylvania MEDICAID 0012823420005

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