Provider Demographics
NPI:1578640470
Name:DESOUZA, DINEA (MD)
Entity Type:Individual
Prefix:DR
First Name:DINEA
Middle Name:
Last Name:DESOUZA
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 1:10801 LOCKWOOD DRIVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878
Mailing Address - Country:US
Mailing Address - Phone:301-754-3050
Mailing Address - Fax:301-681-0789
Practice Address - Street 1:555 QUINCE ORCHARD ROAD
Practice Address - Street 2:SUITE 350
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878
Practice Address - Country:US
Practice Address - Phone:301-926-3633
Practice Address - Fax:301-948-9884
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0054977208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD088601700Medicaid