Provider Demographics
NPI:1316946320
Name:CUDA, MARIA A (DO)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:CUDA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82930-5419
Mailing Address - Country:US
Mailing Address - Phone:315-250-2435
Mailing Address - Fax:
Practice Address - Street 1:190 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-9266
Practice Address - Country:US
Practice Address - Phone:307-789-3636
Practice Address - Fax:307-783-8167
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003969A208M00000X, 208M00000X
WY10034A208M00000X
AZ3362207Q00000X
MO2019042042900208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS0008953LOtherMEDICAL LICENSE
IN201047820Medicaid
NY247703OtherSTATE LICENSE
IN000001055014OtherANTHEM
IN02003969AOtherMEDICAL LICENSE
AZ435827Medicaid
WAOP00001657OtherSTATE MEDICAL LICENSE
AZ3362OtherARIZONA MEDICAL LICENSE
WY233863700Medicaid
PAOS0008953LOtherMEDICAL LICENSE