Provider Demographics
NPI:1124540042
Name:TOLEDO SALDARRIAGA, MARIANO ANTONIO (MD)
Entity Type:Individual
Prefix:MR
First Name:MARIANO
Middle Name:ANTONIO
Last Name:TOLEDO SALDARRIAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARIANO
Other - Middle Name:ANTONIO
Other - Last Name:TOLEDO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 468
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-0468
Mailing Address - Country:US
Mailing Address - Phone:207-858-8367
Mailing Address - Fax:207-474-9261
Practice Address - Street 1:46 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976-1481
Practice Address - Country:US
Practice Address - Phone:207-474-5121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MEMD23412207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program