Healthcare Provider Details

I. General information

NPI: 1427030949
Provider Name (Legal Business Name): ROBERT C MARCIANO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1309 10TH AVE W
MOBRIDGE SD
57601-1146
US

IV. Provider business mailing address

1309 10TH AVE W
MOBRIDGE SD
57601-1146
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-3692
  • Fax: 605-845-8252
Mailing address:
  • Phone: 605-845-3692
  • Fax: 605-845-8252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4891
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: