Healthcare Provider Details

I. General information

NPI: 1205362043
Provider Name (Legal Business Name): ERIC L. MARANDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

178 S 32ND ST W STE 3
BILLINGS MT
59102-6889
US

IV. Provider business mailing address

178 S 32ND ST W STE 3
BILLINGS MT
59102-6889
US

V. Phone/Fax

Practice location:
  • Phone: 406-702-1323
  • Fax:
Mailing address:
  • Phone: 305-409-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number98511
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number98511
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number98511
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: