Provider Demographics
NPI:1881968543
Name:MARCIANO, RUDOLPH DANIEL III (DO)
Entity type:Individual
Prefix:
First Name:RUDOLPH
Middle Name:DANIEL
Last Name:MARCIANO
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:43 WHITING HILL RD STE 300
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1006
Mailing Address - Country:US
Mailing Address - Phone:207-973-9949
Mailing Address - Fax:207-973-9555
Practice Address - Street 1:417 STATE STREET
Practice Address - Street 2:WEBBER EAST, STE 221
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-973-9949
Practice Address - Fax:207-973-9555
Is Sole Proprietor?:No
Enumeration Date:2012-02-28
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEDO2328207T00000X
ME11111111207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery