Provider Demographics
NPI:1598739534
Name:SOM, ANANDA (MD)
Entity Type:Individual
Prefix:
First Name:ANANDA
Middle Name:
Last Name:SOM
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:PO BOX 1921
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34697-1921
Mailing Address - Country:US
Mailing Address - Phone:727-738-0220
Mailing Address - Fax:727-734-7072
Practice Address - Street 1:30522 US 19 N STE 109
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-4436
Practice Address - Country:US
Practice Address - Phone:727-738-0220
Practice Address - Fax:727-734-7072
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0075466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254433400Medicaid
1627837OtherFIRST HEALTH
0407698OtherUNITED HEALTHCARE
110239219OtherRAILROAD MEDICARE
213422OtherAMERIGROUP
244046OtherAVMED
410972OtherTUFTS HEALTH PLAN
P2746142OtherOXFORD HEALTH INSURANCE
5306646OtherAETNA
43705OtherBLUE CROSS BLUE SHIELD
3087332OtherCIGNA
43705Medicare ID - Type Unspecified
110239219OtherRAILROAD MEDICARE
43705YMedicare ID - Type Unspecified