Basic Information
| Provider Information | |||||||||
| NPI: | 1154748598 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARINELLO SURGICAL SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12720 FOXSTONE RD | ||||||||
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| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231132280 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 12720 FOXSTONE RD | ||||||||
| Address2: | |||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231132280 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048938540 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2014 | ||||||||
| LastUpdateDate: | 04/02/2014 | ||||||||
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| AuthorizedOfficialLastName: | MARINELLO | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 8048938540 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0101247633 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.