MARCIANO, PAUL THOMAS (DPM)

Provider Demographics

• NPI: 1558321810
• Name: MARCIANO, PAUL THOMAS (DPM)
• Entity Type: Individual
• First Name: PAUL
• Middle Name: THOMAS
• Last Name: MARCIANO
• Gender: M
• Credentials: DPM
• Mailing Address - Street 1: 1940 E HWY 114
• Mailing Address - Street 2: SUITE 150
• Mailing Address - City: SOUTHLAKE
• Mailing Address - State: TX
• Mailing Address - Zip Code: 76092-6510
• Mailing Address - Country: US
• Mailing Address - Phone: 817-424-3668
• Mailing Address - Fax: 817-442-8637
• Practice Address - Street 1: 1940 E STATE HIGHWAY 114
• Practice Address - Street 2: SUITE 150
• Practice Address - City: SOUTHLAKE
• Practice Address - State: TX
• Practice Address - Zip Code: 76092-6526
• Practice Address - Country: US
• Practice Address - Phone: 817-424-3668
• Practice Address - Fax: 817-442-8637
• Is Sole Proprietor?: No
• Enumeration Date: 2006-03-23
• Last Update Date: 2020-05-22

Provider Licenses

State	License ID	Taxonomies
TX	1364	213E00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	213E00000X	Podiatric Medicine & Surgery Service Providers	Podiatrist

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	1932493574	Other	GROUP NPI
TX	8J0650	Other	BCBS INDV. ID
TX	2441376	Other	AETNA
TX	0031NJ	Other	BCBS GROUP
TX	1356541346	Other	GROUP NPI
	1376738971	Other	GROUP NPI
	1346477304	Other	GROUP NPI
TX	603978000	Other	WORK COMP ID
TX	1356541346	Other	GROUP NPI
	1932493574	Other	GROUP NPI
	1376738971	Other	GROUP NPI
TX	603978000	Other	WORK COMP ID
TX	U66467	Medicare UPIN
TX	8F2183	Medicare PIN
TX	0031NJ	Other	BCBS GROUP
	1346477304	Other	GROUP NPI
	1376738971	Other	GROUP NPI
TX	5330820001	Medicare NSC