Provider Demographics
NPI:1033361142
Name:SOMA, MARLENE A (MD, FRACS)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:A
Last Name:SOMA
Suffix:
Gender:F
Credentials:MD, FRACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:ML 2018
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-2287
Mailing Address - Fax:513-636-8133
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 2018
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-2287
Practice Address - Fax:513-636-8133
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHACKNOWLEDGMENT LETTE390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program