Provider Demographics
NPI:1548379621
Name:MARCIANO, BENEDICT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:BENEDICT
Middle Name:JOHN
Last Name:MARCIANO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 576649
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95357-6649
Mailing Address - Country:US
Mailing Address - Phone:209-573-3333
Mailing Address - Fax:209-491-7184
Practice Address - Street 1:53 ELMWOOD DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-4183
Practice Address - Country:US
Practice Address - Phone:925-487-9337
Practice Address - Fax:925-833-8556
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2011-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA0448072083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA044807Medicare UPIN