Provider Demographics
NPI:1609850239
Name:SOMERS, DEBRA LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNNE
Last Name:SOMERS
Suffix:
Gender:F
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 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-602-8900
Mailing Address - Fax:215-602-8904
Practice Address - Street 1:9331 OLD BUSTLETON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115-4204
Practice Address - Country:US
Practice Address - Phone:215-602-8900
Practice Address - Fax:215-602-8904
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045330L207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0571741000OtherINDEPENDENCE BLUE CROSS
PA5305OtherBRAVO HEALTH
PA001689793Medicaid
PA30038142OtherKEYSTONE MERCY
PA1549835OtherUNITED HEALTHCARE
PA160042281OtherRAILROAD MEDICARE
PA454528OtherCOVENTRY HEALTH AMRICA
PA4556350OtherAETNA PPO
PA729456OtherHIGHMARK BLUE SHIELD
PA2Y7276OtherHEALTH NET
PA1075782OtherKEYSTONE MERCY
PA4556350OtherAETNA PPO
PA001689793Medicaid