Provider Demographics
NPI:1871789180
Name:DONOHUE-DE SOUZA, KATHRYN ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:ANNE
Last Name:DONOHUE-DE SOUZA
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:BOX AP 59223
Mailing Address - Street 2:SLOT 390
Mailing Address - City:NASSAU
Mailing Address - State:NEW PROVIDENCE
Mailing Address - Zip Code:00000
Mailing Address - Country:BS
Mailing Address - Phone:242-702-4609
Mailing Address - Fax:242-702-4624
Practice Address - Street 1:BOX AP 59223
Practice Address - Street 2:SLOT 390
Practice Address - City:NASSAU
Practice Address - State:NEW PROVIDENCE
Practice Address - Zip Code:00000
Practice Address - Country:BS
Practice Address - Phone:242-702-4609
Practice Address - Fax:242-702-4624
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY194404208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY194404OtherNEW YORK STATE