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Contact Information

BRYAN X DESOUZA, MD
100 E LANCASTER AVE
SUITE 312
WYNNEWOOD, PA19096-3450
 Phone: 610-649-6090
 Fax: 610-640-6087
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical Neurophysiology

2084N0600X 86 Physician/Neuropsychiatry
 

Neurology

2084N0400X 13 Physician/Neurology
Indicates primary specialty

NPI Profile & details for BRYAN X DESOUZA · (Male)

NPI Number 1427138486
Status Active
Credentials MD
Entity Individual
Enumeration date 10/16/2006
Last updated 09/11/2025 - About 9 months ago
Sole proprietor 1 Yes
Identifiers
  • PA License # MD052950L
  • PA Medicaid 1483921
  • PA Other 481009 AETNA
  • PA Other 438218 AMERIHEALTH/KEYSTONE
  • PA Other DE438218 BLUE CROSS BLUE SHIELD
  • PA Other DE438218 BLUE SHIELD
  • PA Other 0792085-007 CIGNA
  • PA Other 0727230000 KEYSTONE HEALTH PLAN EAST
Hospital affiliation(s)
  • MAIN LINE HOSPITAL BRYN MAWR CAMPUS - (Acute Care)
    130 SOUTH BRYN MAWR AVE
    BRYN MAWR, PA 19010
  • MAIN LINE HOSPITAL LANKENAU - (Acute Care)
    100 LANCASTER AVE
    WYNNEWOOD, PA 19096
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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