Provider Demographics
NPI:1457462673
Name:DITOMASSO, MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:DITOMASSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 GRANDVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2509
Mailing Address - Country:US
Mailing Address - Phone:203-573-6525
Mailing Address - Fax:203-573-7240
Practice Address - Street 1:88 GRANDVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2509
Practice Address - Country:US
Practice Address - Phone:203-573-6525
Practice Address - Fax:203-573-7240
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0347652084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
BD5402451OtherDEA
G85199Medicare UPIN