Provider Demographics
NPI:1720308489
Name:MIANO, MARLEA (MD)
Entity Type:Individual
Prefix:
First Name:MARLEA
Middle Name:
Last Name:MIANO
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 1:1700 LYONS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1882
Mailing Address - Country:US
Mailing Address - Phone:937-438-9100
Mailing Address - Fax:937-438-9200
Practice Address - Street 1:1700 LYONS RD
Practice Address - Street 2:SUITE A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1882
Practice Address - Country:US
Practice Address - Phone:937-438-9100
Practice Address - Fax:937-438-9200
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH099259207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine