Healthcare Provider Details

I. General information

NPI: 1083993224
Provider Name (Legal Business Name): LUIZ MARACAJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LUIZ FERREIRA MARACAJA NETO MD

II. Dates (important events)

Enumeration Date: 08/05/2011
Last Update Date: 06/23/2020
Certification Date: 06/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

333 CEDAR STREET TMP 3
NEW HAVEN CT
06512
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-2802
  • Fax: 203-785-6664
Mailing address:
  • Phone: 203-785-2802
  • Fax: 203-785-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberQ0751
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number051620
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: