Provider Demographics
NPI:1073560736
Name:D'SOUZA, ANTHONY W (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:W
Last Name:D'SOUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 ARLINGTON ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239
Mailing Address - Country:US
Mailing Address - Phone:203-929-9799
Mailing Address - Fax:203-925-8264
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:STE 400
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239
Practice Address - Country:US
Practice Address - Phone:203-929-9799
Practice Address - Fax:203-925-8264
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023268207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010023268CT07OtherANTHEM
CT001232685Medicaid
CTP00060970OtherR.R. MEDICARE
CT010023268CT07OtherANTHEM
CTP00060970OtherR.R. MEDICARE
CT060001563Medicare PIN