Provider Demographics
NPI:1154434199
Name:MARINO, RICK J (MD)
Entity type:Individual
Prefix:DR
First Name:RICK
Middle Name:J
Last Name:MARINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 129TH ST S
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98444-2215
Mailing Address - Country:US
Mailing Address - Phone:253-507-9345
Mailing Address - Fax:253-507-9345
Practice Address - Street 1:1022 129TH ST S
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98444-2215
Practice Address - Country:US
Practice Address - Phone:253-507-9345
Practice Address - Fax:253-507-9345
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA049514207R00000X
WAMD60071497207R00000X
GA071373208M00000X
ORMD167895208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8898942OtherMEDICARE
WA0249460OtherSTATE L&I
WA0276015OtherL&I
WAG8898942OtherMEDICARE
WA0249460OtherSTATE L&I