Provider Demographics
NPI:1982605853
Name:FORMAS, MARIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:E
Last Name:FORMAS
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 1:8955 SW 87TH CT STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2223
Mailing Address - Country:US
Mailing Address - Phone:305-274-1920
Mailing Address - Fax:305-274-3804
Practice Address - Street 1:8955 SW 87TH CT STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2223
Practice Address - Country:US
Practice Address - Phone:305-274-1920
Practice Address - Fax:305-274-3804
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038910207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067928300Medicaid
FL79809BMedicare ID - Type UnspecifiedMEDICARE