Provider Demographics
NPI:1851488647
Name:DOS SANTOS, MARIA JULIA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:JULIA
Last Name:DOS SANTOS
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 1:510 SPRING STREET
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130
Mailing Address - Country:US
Mailing Address - Phone:812-282-1888
Mailing Address - Fax:812-218-9318
Practice Address - Street 1:510 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3554
Practice Address - Country:US
Practice Address - Phone:812-282-1888
Practice Address - Fax:812-218-9318
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY391162084P0800X, 2084P0804X
IN01064162A2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000493570OtherANTHEM #
600014305OtherMAGELLAN MIS #
IN200868210AMedicaid
50704000OtherMAGELLAN GROUP #
KY82900176Medicaid
KY78903689Medicaid
KY65927857Medicaid
000000056294OtherANTHEM GROUP #
IN200868210AMedicaid