Provider Demographics
NPI:1043454382
Name:MARINELLI, KRISTINE MARIE (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:MARIE
Last Name:MARINELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5655 HUDSON DR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4451
Mailing Address - Country:US
Mailing Address - Phone:330-650-2111
Mailing Address - Fax:330-650-2211
Practice Address - Street 1:5655 HUDSON DR
Practice Address - Street 2:305
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4451
Practice Address - Country:US
Practice Address - Phone:330-650-2111
Practice Address - Fax:330-650-2211
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350983392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry