Provider Demographics
NPI:1164699740
Name:SOUKOULIS, INES W (MD)
Entity Type:Individual
Prefix:
First Name:INES
Middle Name:W
Last Name:SOUKOULIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:INES
Other - Middle Name:B
Other - Last Name:WU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 PETER JEFFERSON PKWY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8835
Mailing Address - Country:US
Mailing Address - Phone:434-984-2400
Mailing Address - Fax:434-984-2400
Practice Address - Street 1:600 PETER JEFFERSON PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8835
Practice Address - Country:US
Practice Address - Phone:434-984-2400
Practice Address - Fax:434-984-2400
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA247534207N00000X
VA0101256447207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology