MEDICARE: MR. EDWARD D MARIANO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	25890	LA

General Provider Information

NPI Number	:	1891765699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD D MARIANO M.D.

Provider Business Mailing Address
First Line	:	1200 S FARMERVILLE ST
Second Line	:
City	:	RUSTON
State	:	LA
Zip	:	71270-5941
Country	:	US
Telephone Number	:	318-255-3690
Fax Number	:

Provider Business Practice Location Address
First Line	:	165 BEECH SPRINGS RD
Second Line	:
City	:	JONESBORO
State	:	LA
Zip	:	71251-2059
Country	:	US
Telephone Number	:	318-259-4435
Fax Number	:	318-259-0019

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	01/06/2022

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