Provider Demographics
NPI:1063457448
Name:SOUZA & ASSOCIATES, INC., P.C.
Entity Type:Organization
Organization Name:SOUZA & ASSOCIATES, INC., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CESAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-572-3323
Mailing Address - Street 1:PO BOX 444
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0444
Mailing Address - Country:US
Mailing Address - Phone:434-572-3323
Mailing Address - Fax:434-572-6716
Practice Address - Street 1:2204 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1645
Practice Address - Country:US
Practice Address - Phone:434-517-3139
Practice Address - Fax:434-572-6716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0249AOtherNORTH CAROLINA BLUE CROSS
NC890249AMedicaid
NC890249AMedicaid