Provider Demographics
NPI:1366493132
Name:ELEANOR C. MARIANO MD PC
Entity Type:Organization
Organization Name:ELEANOR C. MARIANO MD PC
Other - Org Name:CENTER FOR EXECUTIVE MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-945-2494
Mailing Address - Street 1:PO BOX 30907
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85046-0907
Mailing Address - Country:US
Mailing Address - Phone:480-945-2494
Mailing Address - Fax:480-323-2699
Practice Address - Street 1:8757 E BELL RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1322
Practice Address - Country:US
Practice Address - Phone:480-945-2494
Practice Address - Fax:480-323-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109130Medicare PIN