Provider Demographics
NPI:1932196631
Name:MARIANI, RAYMOND LEO (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:LEO
Last Name:MARIANI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6101
Mailing Address - Country:US
Mailing Address - Phone:802-257-7913
Mailing Address - Fax:
Practice Address - Street 1:142 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6101
Practice Address - Country:US
Practice Address - Phone:802-257-7913
Practice Address - Fax:802-257-7913
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT78213E00000X
NHNH116213E00000X
MAMA1390213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0008307Medicaid
VT0323934Medicaid
P00160777OtherRR MEDICARE
T25417Medicare UPIN
VTMAVT8307Medicare ID - Type Unspecified
Y70565Medicare ID - Type Unspecified