Glen A Marino, MD

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

MD046567L Issued in PA

Practice address

420 S Jackson St
Pottsville, PA 17901-3625

Phone

(570) 621-5210

Fax

(570) 621-9301

NPI assigned

Jul 8, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lehigh Valley Hospital - Schuylkill

  • Community/Retail Pharmacy
  • Pottsville, PA
  • NPI 1497377501
  NPD (past)
• Schuylkill Rehabilitation Center, Inc.

  • Clinic/Center
  • Pottsville, PA
  • NPI 1174522205
  NPD (past)

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1902804511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 327",
            "city": "ORWIGSBURG",
            "state": "PA",
            "postal_code": "179610327",
            "telephone_number": "570-621-5121",
            "fax_number": "570-621-9301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S JACKSON ST",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013625",
            "telephone_number": "570-621-5210",
            "fax_number": "570-621-9301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARINO",
        "first_name": "GLEN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "PA",
            "license": "MD046567L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0012823420005",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jillian Ann Marcalus, BSN
• Amanda L Marchetti, PTA
• Christopher Marcolla
• Sarah Mary Marconis, CRNP
• Danielle Elizabeth Marino, MS, RDN, LDN
• Gabrielle Markiewicz
• Jill Markovich
• Jason Emanuel Marks, PT
• Marshall-Rismiller & Associates
• Lisa M. Marsicano, LCSW

• Neuromusculoskeletal Medicine & OMM Physician in Pottsville, PA
• Providers in Pottsville, PA by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.