Provider Demographics
NPI:1568678316
Name:SOM, SANTANU (MD, DO)
Entity Type:Individual
Prefix:DR
First Name:SANTANU
Middle Name:
Last Name:SOM
Suffix:
Gender:M
Credentials:MD, DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4813
Mailing Address - Country:US
Mailing Address - Phone:716-297-2052
Mailing Address - Fax:716-215-6170
Practice Address - Street 1:3117 MILITARY RD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4813
Practice Address - Country:US
Practice Address - Phone:716-297-2052
Practice Address - Fax:716-215-6170
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242962207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY564291Medicare PIN
NYG400009078Medicare PIN
NYA400019870Medicare PIN