Provider Demographics
NPI:1376566760
Name:CLUBB, SONI KEVIN PATTERSON (MD)
Entity Type:Individual
Prefix:DR
First Name:SONI
Middle Name:KEVIN PATTERSON
Last Name:CLUBB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:PATTERSON
Other - Last Name:CLUBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:JOHN DEMPSEY HOSPITAL
Mailing Address - Street 2:263 FARMINGTON AVENUE, MC-2801
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-679-2588
Mailing Address - Fax:860-670-4015
Practice Address - Street 1:JOHN DEMPSEY HOSPITAL
Practice Address - Street 2:263 FARMINGTON AVENUE, MC-2801
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-679-7514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033858207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine