Provider Demographics
NPI:1295994721
Name:DIMAYA, ANN CELESTE MAPAS (MD)
Entity type:Individual
Prefix:DR
First Name:ANN CELESTE
Middle Name:MAPAS
Last Name:DIMAYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANN CELESTE
Other - Middle Name:
Other - Last Name:MAPAS-DIMAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:190 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-3042
Mailing Address - Country:US
Mailing Address - Phone:203-467-2102
Mailing Address - Fax:203-467-1859
Practice Address - Street 1:190 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06512-3042
Practice Address - Country:US
Practice Address - Phone:203-467-2101
Practice Address - Fax:203-467-1859
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT49216207RG0300X, 207RH0002X, 207R00000X
NY003185207RG0300X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008070777Medicaid
CTD400032402Medicare PIN