Provider Demographics
NPI:1356440614
Name:SANTA MARIA, MICHAEL PHILLIP (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:PHILLIP
Last Name:SANTA MARIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 MAPLE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2779
Mailing Address - Country:US
Mailing Address - Phone:716-687-8748
Mailing Address - Fax:716-687-8753
Practice Address - Street 1:1825 MAPLE RD STE 200
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2779
Practice Address - Country:US
Practice Address - Phone:716-687-8748
Practice Address - Fax:716-687-8753
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014396103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025453102OtherUNIVERA PROVIDER NUMBER
NY492457OtherVALUE OPTIONS
NY000526368004OtherBLUE CROSS/COMMUNITY BLUE
NY02186592Medicaid
NY9711291OtherINDEPENDENT HEALTH
NY00025453102OtherUNIVERA PROVIDER NUMBER
NY9711291OtherINDEPENDENT HEALTH