Healthcare Provider Details

I. General information

NPI: 1518167824
Provider Name (Legal Business Name): BENJAMIN D'SOUZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2007
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1865 RT 70 STE 260
CHERRY HILL NJ
08003-0300
US

IV. Provider business mailing address

1865 RT 70 STE 260
CHERRY HILL NJ
08003-0300
US

V. Phone/Fax

Practice location:
  • Phone: 856-216-0300
  • Fax: 856-216-7142
Mailing address:
  • Phone: 856-216-0300
  • Fax: 856-216-7142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberMD439701
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA09592800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: