Provider Demographics
NPI:1558475004
Name:SOMMA, JOSEPH J (CRNA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:J
Last Name:SOMMA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:C/O EMMC
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0404
Mailing Address - Country:US
Mailing Address - Phone:207-973-4519
Mailing Address - Fax:207-992-4132
Practice Address - Street 1:489 STATE ST
Practice Address - Street 2:EMMC
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6616
Practice Address - Country:US
Practice Address - Phone:207-973-4519
Practice Address - Fax:207-992-4132
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME045654367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201020OtherCOASTAL EYE SURGERY CENTER
MEJX1787OtherMEDICARE NUMBER FOR BHMH
ME200051OtherBHMH
MEJX1787OtherMEDICARE NUMBER FOR BHMH
MEMM960102Medicare PIN
MEMM850101Medicare PIN
MEMM9601Medicare ID - Type Unspecified