Provider Demographics
NPI:1356321368
Name:ROY, SOMNATH DANDAPAT (MD,)
Entity Type:Individual
Prefix:
First Name:SOMNATH
Middle Name:DANDAPAT
Last Name:ROY
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 1:125 E BROAD ST
Mailing Address - Street 2:SUITE #122
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6400
Mailing Address - Country:US
Mailing Address - Phone:440-329-7350
Mailing Address - Fax:440-329-7349
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:SUITE #122
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6400
Practice Address - Country:US
Practice Address - Phone:440-329-7350
Practice Address - Fax:440-329-7349
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-5700-R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110227457OtherRAILROAD MEDICARE
OH2135415Medicaid
OH36D0997547OtherCLIA NUMBER
OH2843810Medicaid
OH000000211231OtherANTHEM BCBS
OH93370OtherQUAL CHOICE
OH341967335OtherCARESOURCE
OH000000211231OtherANTHEM BCBS
OH110227457OtherRAILROAD MEDICARE