Healthcare Provider Details

I. General information

NPI: 1962931295
Provider Name (Legal Business Name): VINCENT JOSEPH MARIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBRAHAM ROAD 2ND FLOOR
SPRINGFIELD MA
01109-3161
US

IV. Provider business mailing address

280 CHESTNUT STREET 2ND FL
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-793-2511
  • Fax: 413-794-8428
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1014804
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number1014804
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: