Provider Demographics
NPI:1578573010
Name:SARKAR, SOUMITRA (MD)
Entity Type:Individual
Prefix:DR
First Name:SOUMITRA
Middle Name:
Last Name:SARKAR
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 1:2614 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2310
Mailing Address - Country:US
Mailing Address - Phone:323-728-0653
Mailing Address - Fax:323-728-8369
Practice Address - Street 1:2614 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2310
Practice Address - Country:US
Practice Address - Phone:323-728-0653
Practice Address - Fax:323-728-8369
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53499207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110208996OtherRAILROAD MEDICARE PROVIDE
CA00A534990Medicaid
CAZZZ61586ZOtherBLUE SHIELD
CAW14936Medicare ID - Type Unspecified
CA110208996OtherRAILROAD MEDICARE PROVIDE