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General NPI Number Information
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NPI Number | 1861952434
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Entity Type | Individual
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Provider Name | STEVE MARK D'SOUZA MD
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Gender | Male
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Dates
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Enumeration Date | 03/20/2019
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Last Update Date | 12/20/2022
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Provider Practice Location Address
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Address Line | 721 FAIRFAX AVE
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City | NORFOLK
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State | VA
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Zip | 23507-2007
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Country | US
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Telephone | 757-446-7934
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Fax |
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Provider Business Mailing Address
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Address Line | 817 MANTEO ST APT 7
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City | NORFOLK
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State | VA
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Zip | 23507-1634
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Country | US
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Telephone | 703-678-9268
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101276429
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License Number State | VA
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