Provider Demographics
NPI:1962644385
Name:DESOUSA, DONNA (DO)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:DESOUSA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:GOLDISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 PARK ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5230
Practice Address - Country:US
Practice Address - Phone:508-771-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT012757207L00000X
NY260753-1207L00000X
MA262029207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology