Healthcare Provider Details

I. General information

NPI: 1780179671
Provider Name (Legal Business Name): JESSICA THERESA D'SOUZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 NEW HOLLAND AVE STE 200
LANCASTER PA
17602-2288
US

IV. Provider business mailing address

718 N PLUM ST
LANCASTER PA
17602-2358
US

V. Phone/Fax

Practice location:
  • Phone: 717-299-6371
  • Fax:
Mailing address:
  • Phone: 314-761-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD474917
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: