Provider Demographics
NPI:1083993224
Name:MARACAJA, LUIZ (MD)
Entity Type:Individual
Prefix:
First Name:LUIZ
Middle Name:
Last Name:MARACAJA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUIZ
Other - Middle Name:
Other - Last Name:FERREIRA MARACAJA NETO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:333 CEDAR STREET
Mailing Address - Street 2:TMP 3
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512
Mailing Address - Country:US
Mailing Address - Phone:203-785-2802
Mailing Address - Fax:203-785-6664
Practice Address - Street 1:20 YORK ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3220
Practice Address - Country:US
Practice Address - Phone:203-785-2802
Practice Address - Fax:203-785-6664
Is Sole Proprietor?:No
Enumeration Date:2011-08-05
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0751207L00000X
390200000X
CT051620207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ0751OtherTEXAS STATE LICENSE
TX340890801Medicaid
CT051620OtherCONNECTICUT STATE LICENSE
TX360456YK00Medicare PIN