Provider Demographics
NPI:1013379619
Name:D'SOUZA, CHRISTOPHER FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:FRANCIS
Last Name:D'SOUZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 S MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3162
Mailing Address - Country:US
Mailing Address - Phone:203-272-7251
Mailing Address - Fax:
Practice Address - Street 1:677 S MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3162
Practice Address - Country:US
Practice Address - Phone:203-272-7251
Practice Address - Fax:203-272-2552
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT06-0646844390200000X
CT62271207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1013379619Medicaid