Provider Demographics
NPI:1326036336
Name:SOMMERS, DAVID IRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:IRA
Last Name:SOMMERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:IRA
Other - Last Name:SOMMERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:3750 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 304
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2136
Mailing Address - Country:US
Mailing Address - Phone:301-933-3018
Mailing Address - Fax:301-933-6855
Practice Address - Street 1:3750 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 304
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2136
Practice Address - Country:US
Practice Address - Phone:301-933-3018
Practice Address - Fax:301-933-6855
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2010-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1304103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0714020Medicaid
MD0714020Medicaid