Provider Demographics
NPI:1245321025
Name:MARCIANO, PATRICIA (CNM)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MARCIANO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 PRUDDEN LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-2327
Mailing Address - Country:US
Mailing Address - Phone:120-329-8458
Mailing Address - Fax:203-332-0876
Practice Address - Street 1:982 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06608-1913
Practice Address - Country:US
Practice Address - Phone:203-696-3260
Practice Address - Fax:203-332-0376
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000004367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004234788Medicaid
NPP000Medicare UPIN
420000192Medicare ID - Type Unspecified