Provider Demographics
NPI:1821316274
Name:SANTOS, MARIA THERESA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:THERESA
Last Name:SANTOS
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 1:711 COTTAGE GROVE ROAD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3060
Mailing Address - Country:US
Mailing Address - Phone:860-242-8756
Mailing Address - Fax:860-242-3052
Practice Address - Street 1:711 COTTAGE GROVE ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3060
Practice Address - Country:US
Practice Address - Phone:860-242-8756
Practice Address - Fax:860-242-3052
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT053575207RC0000X
CT53575207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400221345OtherMEDICARE
CT008057720Medicaid
CTP01712135OtherRAILROAD MEDICARE