MEDICARE: DR. JESSICA THERESA D'SOUZA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD474917	PA

General Provider Information

NPI Number	:	1780179671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSICA THERESA D'SOUZA MD

Provider Business Mailing Address
First Line	:	718 N PLUM ST
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-2358
Country	:	US
Telephone Number	:	314-761-1555
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 NEW HOLLAND AVE STE 200
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17602-2288
Country	:	US
Telephone Number	:	717-299-6371
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2018
Last Update Date	:	05/08/2026

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