Healthcare Provider Details

I. General information

NPI: 1841286390
Provider Name (Legal Business Name): FREDERICK F MARCIANO MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 09/22/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7242 E OSBORN RD #420
SCOTTSDALE AZ
85251
US

IV. Provider business mailing address

2910 N 3RD AVE
PHOENIX AZ
85013-4434
US

V. Phone/Fax

Practice location:
  • Phone: 480-425-8004
  • Fax: 480-425-8002
Mailing address:
  • Phone: 480-425-8004
  • Fax: 480-425-8002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number25348
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: