Individual
ANN M SOUSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
105 MAIN ST, HEBRON, CT 06248-1519
(860) 228-1119
(860) 228-4314
Mailing address
105 MAIN ST, PO BOX 636, HEBRON, CT 06248-1519
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
041639
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040041639CT04
ANTHEM BC & BS OF CT
CT
01
—
041639
CONNECTICARE
CT
01
—
2V6789
HEALTH NET
CT
01
—
3425912
AETNA
CT
01
—
5999285
CIGNA
CT
Enumeration date
06/30/2006
Last updated
07/13/2007
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