1972595874 NPI number — DR. DEAN JOHN MARIANO DO

Table of content: DR. DEAN JOHN MARIANO DO (NPI 1972595874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972595874 NPI number — DR. DEAN JOHN MARIANO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARIANO
Provider First Name:
DEAN
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972595874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2068 BROUGHTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-7311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-977-9805
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2068 BROUGHTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-7311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-977-9805
Provider Business Practice Location Address Fax Number:
830-867-5917
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  0102201558 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: 05010776L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 045817 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: O200621A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 54-1951442 . This is a "BENESIGHT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138385 . This is a "HEALTHKEEPERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 150684200 . This is a "OWCP FED WC VIA ACS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78158 . This is a "SENTARA FAMILY CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78158 . This is a "SENTARA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "MIDATLANTIC HEALTH SOLUTI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7906558 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "VIRGINIA HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78158 . This is a "POS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138385 . This is a "PENINSULA HEALTHCARE INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78158 . This is a "HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138385 . This is a "PRIORITY HEALTH CARE INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "FOCUS WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010063701 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0194252001 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 138385 . This is a "BCBS OF VA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78158 . This is a "PPO" identifier . This identifiers is of the category "OTHER".




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