Provider Demographics
NPI:1851399604
Name:FLORES DIEPPA, MARIA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:S
Last Name:FLORES DIEPPA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:S
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:616 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3212
Mailing Address - Country:US
Mailing Address - Phone:732-548-6303
Mailing Address - Fax:732-548-9822
Practice Address - Street 1:616 GROVE AVE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3212
Practice Address - Country:US
Practice Address - Phone:732-548-6303
Practice Address - Fax:732-548-9822
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04500700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ128988Medicare PIN
E51266Medicare UPIN