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General NPI Number Information
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NPI Number | 1992834089
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Entity Type | Organization
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Legal Business Name | STEPHEN R MARANO MD PC
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Dates
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Enumeration Date | 03/05/2007
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 2375 E SUNNYSIDE RD STE F
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7579
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Country | US
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Telephone | 208-522-6930
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Fax | 208-523-5342
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Provider Business Mailing Address
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Address Line | 2375 E SUNNYSIDE RD STE F
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7579
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Country | US
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Telephone | 208-522-6930
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Fax | 208-523-5342
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Authorized Official
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Title or Position | MD
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Name | STEPHEN R MARANO
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Credential | MD
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Telephone | 208-522-6930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | M5076
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License Number State | ID
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