Provider Demographics
NPI:1164586392
Name:BRAHMANANDAM, SOMA M (MD)
Entity Type:Individual
Prefix:
First Name:SOMA
Middle Name:M
Last Name:BRAHMANANDAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 REDBUD WAY
Mailing Address - Street 2:APT. #23
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752
Mailing Address - Country:US
Mailing Address - Phone:508-277-1985
Mailing Address - Fax:
Practice Address - Street 1:15 REDBUD WAY
Practice Address - Street 2:APT. #23
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-277-1985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230626208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery