Provider Demographics
NPI:1346770559
Name:MARINO, ELIZABETH JEAN (RD, LD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JEAN
Last Name:MARINO
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:JEAN
Other - Last Name:BEDELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 N CRAIG ST STE 503
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 N CRAIG ST STE 503
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1567
Practice Address - Country:US
Practice Address - Phone:412-684-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN006201133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered