Provider Demographics
NPI:1760898191
Name:SIKDAR, SOMA
Entity Type:Individual
Prefix:
First Name:SOMA
Middle Name:
Last Name:SIKDAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 KING ST W
Mailing Address - Street 2:DEPARTMENT OF LABORATORY MEDICINE GRAND RIVER HOSPITAL
Mailing Address - City:KITCHENER
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N2G1G3
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:835 KING ST W
Practice Address - Street 2:DEPARTMENT OF LABORATORY MEDICINE GRAND RIVER HOSPITAL
Practice Address - City:KITCHENER
Practice Address - State:ONTARIO
Practice Address - Zip Code:N2G1G3
Practice Address - Country:CA
Practice Address - Phone:519-749-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301103509207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology