Provider Demographics
NPI:1043302797
Name:MARIANO, ARTHUR S (MD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:S
Last Name:MARIANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ARTHUR
Other - Middle Name:A
Other - Last Name:MARIANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3625 STATE ROAD 60 E
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33594-3586
Mailing Address - Country:US
Mailing Address - Phone:813-661-2525
Mailing Address - Fax:813-651-0591
Practice Address - Street 1:3625 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3586
Practice Address - Country:US
Practice Address - Phone:813-661-2525
Practice Address - Fax:813-651-0591
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28133207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00288OtherSTAYWELL/HEALTHEASE
FL202312OtherAMERIGROUP
FL051353900Medicaid
FL30596Medicare ID - Type Unspecified
FLD87775Medicare UPIN