Provider Demographics
NPI:1073585865
Name:SOUCY, DENISE MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MICHELLE
Last Name:SOUCY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4614
Mailing Address - Country:US
Mailing Address - Phone:207-563-6623
Mailing Address - Fax:207-563-6625
Practice Address - Street 1:68 CHAPMAN ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4614
Practice Address - Country:US
Practice Address - Phone:207-563-6623
Practice Address - Fax:207-563-6625
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0124946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E52613OtherHARVARD PILGRIM
060977OtherANTHEM
3378355OtherAETNA
9962527OtherCIGNA
E52613Medicare UPIN
MEMM3181Medicare ID - Type UnspecifiedMEDICARE