Provider Demographics
NPI:1205821410
Name:SOMMER, CHARLES A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:SOMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-4000
Mailing Address - Country:US
Mailing Address - Phone:508-764-2772
Mailing Address - Fax:508-764-2833
Practice Address - Street 1:94 SOUTH ST
Practice Address - Street 2:
Practice Address - City:SOUTHBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01550-4000
Practice Address - Country:US
Practice Address - Phone:508-764-2772
Practice Address - Fax:508-764-2833
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA159558174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3199100Medicaid
B83374Medicare UPIN
P00088530Medicare PIN
MAA29858Medicare PIN
MAA2985801Medicare PIN