Individual
DR. BRYAN XAVIER DESOUZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 E LANCASTER AVE, SUITE 312, WYNNEWOOD, PA 19096-3450
(610) 649-6090
(610) 640-6087
Mailing address
100 E LANCASTER AVE, SUITE 312, WYNNEWOOD, PA 19096-3450
(610) 649-6090
(610) 640-6087
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
MD052950L
PA
2084N0600X
Clinical Neurophysiology Physician
Primary
MD052950L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0727230000
KEYSTONE HEALTH PLAN EAST
PA
01
—
0792085-007
CIGNA
PA
05
—
1483921
—
PA
01
—
438218
AMERIHEALTH/KEYSTONE
PA
01
—
481009
AETNA
PA
01
—
DE438218
BLUE CROSS BLUE SHIELD
PA
Enumeration date
10/16/2006
Last updated
09/11/2025
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