Provider Demographics
NPI:1710008925
Name:D'SOUZA, BERNADETTE B (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:B
Last Name:D'SOUZA
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 1:1 ELIZABETH PL
Mailing Address - Street 2:SUITE G3
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3445
Mailing Address - Country:US
Mailing Address - Phone:937-281-0900
Mailing Address - Fax:937-424-1052
Practice Address - Street 1:1 ELIZABETH PL
Practice Address - Street 2:SUITE G3
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3445
Practice Address - Country:US
Practice Address - Phone:937-281-0900
Practice Address - Fax:937-424-1052
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH426022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0648384Medicaid