Provider Demographics
NPI:1609857747
Name:SOUCY, ROBERT G JR (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:SOUCY
Suffix:JR
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 1:9 OAKES RD
Mailing Address - Street 2:
Mailing Address - City:COLEBROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03576-6117
Mailing Address - Country:US
Mailing Address - Phone:603-237-5008
Mailing Address - Fax:281-393-4203
Practice Address - Street 1:9 OAKES RD
Practice Address - Street 2:
Practice Address - City:COLEBROOK
Practice Address - State:NH
Practice Address - Zip Code:03576-6117
Practice Address - Country:US
Practice Address - Phone:603-237-5008
Practice Address - Fax:281-393-4203
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0000101Medicaid
0405411Y0NH02OtherANTHEM NH
NH3094399Medicaid
8080OtherVTBLUE
NH21211OtherCIGNA
VT341982OtherMVP
NH80159325OtherRR MEDICARE
NH30002940Medicaid
A78574OtherTRICARE
0405411Y0NH03OtherANTHEM NH
VT341982OtherMVP
A78574Medicare UPIN
NH3094399Medicaid