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General NPI Number Information
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NPI Number | 1972595874
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Entity Type | Individual
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Provider Name | DEAN JOHN MARIANO DO
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Gender | Male
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 2068 BROUGHTON ST
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City | CARMEL
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State | IN
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Zip | 46032-7311
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Country | US
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Telephone | 860-977-9805
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Fax | 830-867-5917
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Provider Business Mailing Address
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Address Line | 2068 BROUGHTON ST
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City | CARMEL
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State | IN
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Zip | 46032-7311
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Country | US
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Telephone | 860-977-9805
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 0102201558
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 05010776L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 045817
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | O200621A
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License Number State | IN
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