Provider Demographics
NPI:1902836984
Name:STAMP, MARIA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LOUISE
Last Name:STAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-3616
Mailing Address - Fax:219-364-3610
Practice Address - Street 1:336 W US HIGHWAY 30
Practice Address - Street 2:STEA
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-5345
Practice Address - Country:US
Practice Address - Phone:219-464-7430
Practice Address - Fax:219-464-8014
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM8681207P00000X
WAMD00043551207Q00000X
IN01068785A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDI46869Medicare UPIN