Provider Demographics
NPI:1699815837
Name:D'SOUZA, SAROJ N (MD)
Entity Type:Individual
Prefix:DR
First Name:SAROJ
Middle Name:N
Last Name:D'SOUZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NOREEN
Other - Middle Name:S
Other - Last Name:D'SOUZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:544 N NEW BALLAS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6841
Mailing Address - Country:US
Mailing Address - Phone:314-569-1999
Mailing Address - Fax:314-569-4088
Practice Address - Street 1:544 N NEW BALLAS RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6841
Practice Address - Country:US
Practice Address - Phone:314-569-1999
Practice Address - Fax:314-569-4088
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR2E63207SC0300X, 207SG0201X, 207SM0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics
Not Answered207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
Not Answered207SM0001XAllopathic & Osteopathic PhysiciansMedical GeneticsMolecular Genetic Pathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD83435Medicare UPIN