Healthcare Provider Details

I. General information

NPI: 1558332155
Provider Name (Legal Business Name): MARIA MANUELA DA COSTA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GRAND ST
NEW BRITAIN CT
06052-2016
US

IV. Provider business mailing address

836 FARMINGTON AVE SUITE 102
WEST HARTFORD CT
06119-1505
US

V. Phone/Fax

Practice location:
  • Phone: 860-224-5011
  • Fax: 860-224-5752
Mailing address:
  • Phone: 860-232-9209
  • Fax: 860-232-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number027909
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: