Andre Jerome Marin, SUB IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

17 Cypress LN
Groton, CT 06340-3004

Phone

(216) 256-3186

NPI assigned

Mar 10, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299715200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299715200000",
    "number": "1649578915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 CYPRESS LN",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063403004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 CYPRESS LN",
            "city": "GROTON",
            "state": "CT",
            "postal_code": "063403004",
            "telephone_number": "216-256-3186"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIN",
        "first_name": "ANDRE",
        "middle_name": "JEROME",
        "credential": "SUB IDC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-10",
        "last_updated": "2011-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Anthony Maldonado-Rivera
• Parris Malhoit
• Mark Mammoth
• Jane Sinclair Manaras, OTR/L
• Nicholas Manjarrez, IDC
• Stefanie M Marino-Goodrich, LMFT
• John Marsella
• Jennifer E Marshall, MD
• Sonya Lisa Marshall, DPM
• Abigail Elizabeth Marter, NPC

• Independent Duty Corpsman in Groton, CT
• Providers in Groton, CT by specialty
• Independent Duty Corpsman in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.