Healthcare Provider Details

I. General information

NPI: 1508834375
Provider Name (Legal Business Name): MARIA C LAWLESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA C SANTA ANA M.D.

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 10/24/2020
Certification Date: 10/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 S 6TH ST
VINCENNES IN
47591-1022
US

IV. Provider business mailing address

520 S 7TH ST
VINCENNES IN
47591-1038
US

V. Phone/Fax

Practice location:
  • Phone: 812-885-8497
  • Fax: 812-885-8499
Mailing address:
  • Phone: 812-882-5220
  • Fax: 812-885-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.140704
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01045505A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01045505A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: