Provider Demographics
NPI:1467405951
Name:SONI, ANANT B (MD)
Entity Type:Individual
Prefix:DR
First Name:ANANT
Middle Name:B
Last Name:SONI
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 1:3124 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8041
Mailing Address - Country:US
Mailing Address - Phone:919-782-5451
Mailing Address - Fax:919-782-9289
Practice Address - Street 1:3124 BLUE RIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8041
Practice Address - Country:US
Practice Address - Phone:919-782-5451
Practice Address - Fax:919-782-9289
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39092207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC562008695OtherFEDERAL TAX ID
NC89-78411Medicaid
NC562008695OtherFEDERAL TAX ID
NCA60710Medicare UPIN