Individual
IVAN D'SOUZA
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1026 UNION RD, WEST SENECA, NY 14224-3449
(716) 712-0861
(716) 712-0862
Mailing address
1026 UNION RD, WEST SENECA, NY 14224-3449
(716) 712-0861
(716) 712-0862
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
193603
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010039703
UNIVERA
NY
01
—
000523040010
BC/BS
NY
05
—
01439454
—
NY
01
—
040426001824
FIDELIS
NY
01
—
0708967
IHA
NY
01
—
144658CK
PREFERRED C ARE
NY
Enumeration date
11/07/2005
Last updated
07/08/2007
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