Provider Demographics
NPI:1457739583
Name:SOUZA, COURTNEY LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LYNNE
Last Name:SOUZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:225 HOPMEADOW ST
Mailing Address - Street 2:
Mailing Address - City:WEATOGUE
Mailing Address - State:CT
Mailing Address - Zip Code:06089-9782
Mailing Address - Country:US
Mailing Address - Phone:860-658-0465
Mailing Address - Fax:860-658-5963
Practice Address - Street 1:375 WILLARD AVE
Practice Address - Street 2:DEPT OF PEDIATRICS
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-2300
Practice Address - Country:US
Practice Address - Phone:860-666-5167
Practice Address - Fax:860-665-8168
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2022-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT064738208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics