Individual
DR. EDUARDO MANUEL MARISTANY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1350 HICKORY ST, MELBOURNE, FL 32901
(321) 434-1771
(321) 434-1775
Mailing address
3300 S FISKE BLVD, ROCKLEDGE, FL 32955-4306
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
068451
GA
207R00000X
Internal Medicine Physician
ME118407
FL
208M00000X
Hospitalist Physician
068451
GA
208M00000X
Hospitalist Physician
Primary
ME118407
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003126901A
—
GA
01
—
01685254
AMERIGROUP
—
05
—
020539000
—
FL
01
—
700336
WELLCARE
—
05
—
GA1378
—
SC
01
—
P01089553
RAILROAD MEDICARE
GA
Enumeration date
05/07/2009
Last updated
10/31/2018
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