Healthcare Provider Details

I. General information

NPI: 1598883043
Provider Name (Legal Business Name): PHILIP MARCIANO, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 03/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9975 TAMIAMI TRL N #4
NAPLES FL
34108-1942
US

IV. Provider business mailing address

9975 TAMIAMI TRL N #4
NAPLES FL
34108-1942
US

V. Phone/Fax

Practice location:
  • Phone: 239-513-1119
  • Fax:
Mailing address:
  • Phone: 239-513-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberME 68618
License Number StateFL

VIII. Authorized Official

Name: DR. PHILIP W MARCIANO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 239-513-1119