Provider Demographics
NPI:1871682260
Name:SOMAYAJI, PRABHAKARA (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHAKARA
Middle Name:
Last Name:SOMAYAJI
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 1:549 4TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-1530
Mailing Address - Country:US
Mailing Address - Phone:716-285-0853
Mailing Address - Fax:716-284-2034
Practice Address - Street 1:549 4TH ST STE 1
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-1530
Practice Address - Country:US
Practice Address - Phone:716-285-0853
Practice Address - Fax:716-284-2034
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142353-1174400000X
NY142353208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0032916OtherGHI
NY040426003520OtherFIDELAS
NY1901029OtherINDEPENDENT HEALTH
NY00624828Medicaid
NY00010170301OtherUNIVERA
NY000508061001OtherBLUE CROSS WNY
NY040426003520OtherFIDELAS