Provider Demographics
NPI:1649395138
Name:DSOUZA, YVONNE (MD)
Entity Type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:
Last Name:DSOUZA
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 1:3130 GRAND CONCOURSE
Mailing Address - Street 2:#1E
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458
Mailing Address - Country:US
Mailing Address - Phone:718-295-2454
Mailing Address - Fax:718-584-3206
Practice Address - Street 1:3130 GRAND CONCOURSE
Practice Address - Street 2:1E
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-295-2454
Practice Address - Fax:718-584-3206
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00417809Medicaid
C09615Medicare UPIN
NY00417809Medicaid