Provider Demographics
NPI:1114915923
Name:EDWARD P D'SOUZA MD PC
Entity Type:Organization
Organization Name:EDWARD P D'SOUZA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:D'SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-229-4192
Mailing Address - Street 1:405 8TH AVE NW
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2762
Mailing Address - Country:US
Mailing Address - Phone:605-229-4192
Mailing Address - Fax:605-229-5311
Practice Address - Street 1:405 8TH AVE NW
Practice Address - Street 2:SUITE 302
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-2762
Practice Address - Country:US
Practice Address - Phone:605-229-4192
Practice Address - Fax:605-229-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2011207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7300130Medicaid
SDS682Medicare PIN