Provider Demographics
NPI:1578659298
Name:SOUCY, ANNE JUDITH (MD)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:JUDITH
Last Name:SOUCY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 PRESQUE ISLE ST
Mailing Address - Street 2:
Mailing Address - City:FORT FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04742-1075
Mailing Address - Country:US
Mailing Address - Phone:518-683-0252
Mailing Address - Fax:207-349-4740
Practice Address - Street 1:102 PRESQUE ISLE ST
Practice Address - Street 2:
Practice Address - City:FORT FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04742-1075
Practice Address - Country:US
Practice Address - Phone:518-683-0252
Practice Address - Fax:207-349-4740
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217342207V00000X
MEMD22475207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02414602Medicaid
NY02414602Medicaid
NYJ400087950Medicare PIN