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General NPI Number Information
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NPI Number | 1053694539
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Entity Type | Individual
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Provider Name | TASSCIA M WILLIAMS SOUFFRANT MD
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Gender | Female
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 61 THOMAS JOHNSON DR
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City | FREDERICK
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State | MD
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Zip | 21702-4301
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Country | US
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Telephone | 301-663-6171
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Fax | 301-695-4469
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Provider Business Mailing Address
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Address Line | 3300 S FISKE BLVD
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City | ROCKLEDGE
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State | FL
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Zip | 32955-4306
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Country | US
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Telephone | 321-361-5615
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD458253
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D85692
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME149269
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License Number State | FL
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