Individual
KELLY R DESOUZA-SANDERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
601 WALNUT STREET, SUITE 220E PENNCARE FOR WOMENT, PHILADELPHIA, PA 19106-3304
(215) 521-1400
(215) 521-1422
Mailing address
601 WALNUT STREET, SUITE 220E PENNCARE FOR WOMENT, PHILADELPHIA, PA 19106-3304
(215) 521-1400
(215) 521-1422
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
MD045633
PA
207V00000X
Obstetrics & Gynecology Physician
Primary
MD045633L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013459460001
—
PA
Enumeration date
07/23/2006
Last updated
09/13/2012
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