Provider Demographics
NPI:1114995438
Name:MARIANO, EUFEMIA J A (MD)
Entity Type:Individual
Prefix:
First Name:EUFEMIA
Middle Name:J A
Last Name:MARIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 SOUTH AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-256-3000
Mailing Address - Fax:585-256-3045
Practice Address - Street 1:990 SOUTH AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620
Practice Address - Country:US
Practice Address - Phone:585-256-3000
Practice Address - Fax:585-256-3045
Is Sole Proprietor?:No
Enumeration Date:2006-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1341791207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01252120Medicaid
4345322OtherAETNA
NY2917OtherBLUE SHIELD
NY100818CKOtherPREFERRED CARE
10511421OtherCAQH
10511421OtherCAQH
4345322OtherAETNA