Provider Demographics
NPI:1508349648
Name:ST. CLAIR, MARIA A
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:ST. CLAIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5506 DOLLAR HIDE SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-4113
Mailing Address - Country:US
Mailing Address - Phone:317-830-6264
Mailing Address - Fax:
Practice Address - Street 1:5506 DOLLAR HIDE SOUTH DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-4113
Practice Address - Country:US
Practice Address - Phone:317-830-6264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN49-491420171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty