Provider Demographics
NPI:1821193939
Name:SOMMERS, KEITH L (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:L
Last Name:SOMMERS
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 1:148 TERRY RD
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-5102
Mailing Address - Country:US
Mailing Address - Phone:631-862-4000
Mailing Address - Fax:631-862-4017
Practice Address - Street 1:148 TERRY RD
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-5102
Practice Address - Country:US
Practice Address - Phone:631-862-4000
Practice Address - Fax:631-862-4017
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176445207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113276400OtherEMPIRE
NY0201238OtherGHI
NY0700546OtherUNITED HEALTHCARE
NYCP240OtherOXFORD
NY01438600Medicaid
NY113276400OtherHORIZON
NM4328076OtherAETNA
NYOC5869OtherPHS
NY16481OtherVYTRA
NY176445OtherHIP
NYP62225119OtherMULTIPLAN
NY113276400Other1199
NY123262OtherUS HEALTHCARE
NY4328078OtherCIGNA
NYAH01294OtherMDNY
NY87F373OtherBC/BS
NY113276400OtherEMPIRE
NY4328078OtherCIGNA
NYD92030Medicare UPIN