Provider Demographics
NPI:1922039312
Name:MARIANO, GREGORIO T JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORIO
Middle Name:T
Last Name:MARIANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 BRISTOL LN
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-2901
Mailing Address - Country:US
Mailing Address - Phone:814-696-2978
Mailing Address - Fax:
Practice Address - Street 1:VA MEDICAL CENTER
Practice Address - Street 2:2907 PLEASANT VALLEY BLVD.
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4377
Practice Address - Country:US
Practice Address - Phone:814-943-8164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067679L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine