Provider Demographics
NPI:1588616734
Name:MARIANO, ELEANOR CONNIE (MD)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:CONNIE
Last Name:MARIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29040207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ109131Medicare PIN
AZH32846Medicare UPIN