Provider Demographics
NPI:1477796803
Name:MARIANO, ERIN T (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:T
Last Name:MARIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:95 BULLDOG BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3188
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:1344 S APOLLO BLVD
Practice Address - Street 2:STE D
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-4305
Practice Address - Country:US
Practice Address - Phone:321-724-1084
Practice Address - Fax:321-724-0147
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125116207XX0005X, 207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine