Provider Demographics
NPI:1699727099
Name:PIEDRA, MARIANO M (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANO
Middle Name:M
Last Name:PIEDRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9020 STONY POINT PKWY
Mailing Address - Street 2:STE 240
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235
Mailing Address - Country:US
Mailing Address - Phone:804-282-5236
Mailing Address - Fax:
Practice Address - Street 1:9020 STONY POINT PKWY
Practice Address - Street 2:STE 240
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-282-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010361682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA260015122OtherRAILROAD MEDICARE
VA087637OtherSENTARA
VA096499OtherBC/BS
VA007172109Medicaid
VA35720OtherMDIPA
VA000408OtherVALUE OPTIONS
VA000408OtherVALUE OPTIONS
VA007172109Medicaid