Provider Demographics
NPI:1306895040
Name:MARINO, DAVID (CRNA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MARINO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 DRAKE VIEW CT
Mailing Address - Street 2:
Mailing Address - City:NORTH LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:44452-8572
Mailing Address - Country:US
Mailing Address - Phone:330-727-1461
Mailing Address - Fax:
Practice Address - Street 1:190 N UNION ST
Practice Address - Street 2:STE 104
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1369
Practice Address - Country:US
Practice Address - Phone:330-253-9145
Practice Address - Fax:330-253-6222
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X, 376J00000X
OHRN-233546367500000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2080742Medicaid
OH120778OtherKAISER PERMANENTE INDV #
OH000000125746OtherANTHEM BCBS INDV NUMBER
OH100153OtherEMPLOYER KAISER GROUP #
OH7091249Medicaid
OH2080224OtherUNITED HEALTHCARE GROUP #
OH34-0891295OtherEMPLOYER FEDERAL TAX ID #
OH730592OtherBUCKEYE COMMUNITY HLTH PL
OH2080742Medicaid
OH100153OtherEMPLOYER KAISER GROUP #