1063429165 NPI number — JENNIFER M. SOUZA M.D.

Table of content: (NPI 1790281558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063429165 NPI number — JENNIFER M. SOUZA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUZA
Provider First Name:
JENNIFER
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063429165
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FOXBORO
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02035-1021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-698-0044
Provider Business Mailing Address Fax Number:
508-698-5373

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOXBORO
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02035-1021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-698-0044
Provider Business Practice Location Address Fax Number:
508-698-5373
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  209230 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 92334 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 468086 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA30839 . This is a "HPHC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000030830 . This is a "BMC HEALTHNET" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 410399 . This is a "RI BLUE CHIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1611585 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J25249 . This is a "MABC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0165336 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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