Provider Demographics
NPI:1972595874
Name:MARIANO, DEAN JOHN (DO)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:JOHN
Last Name:MARIANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2068 BROUGHTON ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-7311
Mailing Address - Country:US
Mailing Address - Phone:860-977-9805
Mailing Address - Fax:
Practice Address - Street 1:2068 BROUGHTON ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-7311
Practice Address - Country:US
Practice Address - Phone:860-977-9805
Practice Address - Fax:830-867-5917
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201558207LP2900X
PA05010776L207LP2900X
CT045817208VP0014X
INO200621A208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
54-1951442OtherBENESIGHT
138385OtherHEALTHKEEPERS
150684200OtherOWCP FED WC VIA ACS
78158OtherSENTARA FAMILY CARE
78158OtherSENTARA
54-1951442OtherMIDATLANTIC HEALTH SOLUTI
7906558OtherAETNA
54-1951442OtherVIRGINIA HEALTH NETWORK
78158OtherPOS
138385OtherPENINSULA HEALTHCARE INC
78158OtherHMO
138385OtherPRIORITY HEALTH CARE INC
54-1951442OtherFOCUS WORKERS COMP
VA010063701Medicaid
0194252001OtherCIGNA
138385OtherBCBS OF VA
54-1951442OtherPHCS
78158OtherPPO
78158OtherHMO