Provider Demographics
NPI:1982093019
Name:MARINO, PAUL ANTHONY (FNP-BC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:MARINO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LOCUST LN
Mailing Address - Street 2:
Mailing Address - City:FOLLANSBEE
Mailing Address - State:WV
Mailing Address - Zip Code:26037-1623
Mailing Address - Country:US
Mailing Address - Phone:304-794-6586
Mailing Address - Fax:
Practice Address - Street 1:138 ROCKDALE RD
Practice Address - Street 2:
Practice Address - City:FOLLANSBEE
Practice Address - State:WV
Practice Address - Zip Code:26037-1658
Practice Address - Country:US
Practice Address - Phone:304-527-1747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.16843363LF0000X
WVAPRN75952-FNP-BC363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0120584Medicaid