Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | 0101247229 | VA |
N | 2080P0208X | Pediatric Infectious Diseases | 12553 | ND |
N | 2080P0208X | Pediatric Infectious Diseases | 56374 | MN |
NPI | 1366604878 |
---|---|
Provider Name | Clifford T Mauriello |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Fargo, ND 58102-3641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 20/11/2021 |