Provider Demographics
NPI:1386855435
Name:AVVA, SOMA SUNDARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SOMA
Middle Name:SUNDARAM
Last Name:AVVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5770 WILLOW WALK
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-2620
Mailing Address - Country:US
Mailing Address - Phone:937-275-5600
Mailing Address - Fax:937-275-2696
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:651
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-278-0809
Practice Address - Fax:937-275-2696
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.378302086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery