Individual
LETICIA MARIA BEIRAO COSTA SILVA SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
85 HERRICK ST, BEVERLY, MA 01915-1790
(978) 816-2380
(978) 921-7011
Mailing address
85 HERRICK ST, BEVERLY, MA 01915-1790
(978) 816-2380
(978) 921-7011
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
258345
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110104362A
—
MA
01
—
13558942
CAQH
—
Enumeration date
01/26/2011
Last updated
01/08/2019
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