Provider Demographics
NPI:1104098789
Name:D'SOUZA, BERNARD TUODOR
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:TUODOR
Last Name:D'SOUZA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BERNARD
Other - Middle Name:TUODOR
Other - Last Name:D'SOUZA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:56 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06706-1253
Mailing Address - Country:US
Mailing Address - Phone:203-709-6000
Mailing Address - Fax:
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:ST MARY'S HOSPITAL , DEPARTMENT OF MEDICINE
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06706-1253
Practice Address - Country:US
Practice Address - Phone:203-709-6424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048267207R00000X
CT48267208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT9852543OtherAETNA
CT61470493OtherUHC
CT008017075Medicaid
CT1137283OtherWELLCARE
CT9852543OtherAETNA
CTP01051729Medicare PIN