Provider Demographics
NPI:1548450422
Name:DE SOUSA, MARIA G (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:G
Last Name:DE SOUSA
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 1:950 YALE AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-1858
Mailing Address - Country:US
Mailing Address - Phone:203-265-9600
Mailing Address - Fax:
Practice Address - Street 1:950 YALE AVE
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-1858
Practice Address - Country:US
Practice Address - Phone:203-265-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047417207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine