Healthcare Provider Details

I. General information

NPI: 1558223248
Provider Name (Legal Business Name): DOUGLAS J SOUZA NRCPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 S RIVER RD STE C
BEDFORD NH
03110-6929
US

IV. Provider business mailing address

PO BOX 462
PITTSFIELD ME
04967-0462
US

V. Phone/Fax

Practice location:
  • Phone: 207-977-6444
  • Fax:
Mailing address:
  • Phone: 207-977-6444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberQ5N9J9L8
License Number State
# 3
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: