Provider Demographics
NPI:1508869678
Name:SOUCIER, DONALD (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:SOUCIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-0789
Mailing Address - Country:US
Mailing Address - Phone:860-364-4471
Mailing Address - Fax:860-364-4410
Practice Address - Street 1:50 HOSPITAL HILL RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2096
Practice Address - Country:US
Practice Address - Phone:860-364-4505
Practice Address - Fax:860-364-4506
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000348207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001003483Medicaid
CT060001583Medicare ID - Type Unspecified
CT001003483Medicaid
CTD400006175Medicare PIN