Healthcare Provider Details

I. General information

NPI: 1043204621
Provider Name (Legal Business Name): NEIL F MARIADOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1226 E WATER ST
SYRACUSE NY
13210-1155
US

IV. Provider business mailing address

1226 E WATER ST
SYRACUSE NY
13210-1155
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-3468
  • Fax: 315-214-2840
Mailing address:
  • Phone: 315-478-3468
  • Fax: 315-478-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number212680
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: