Provider Demographics
NPI:1881690642
Name:SOMERS, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:SOMERS
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 1:3555 OLENTANGY RIVER RD
Mailing Address - Street 2:SUITE3080
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3912
Mailing Address - Country:US
Mailing Address - Phone:614-268-6000
Mailing Address - Fax:614-267-1879
Practice Address - Street 1:3555 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 3080
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3912
Practice Address - Country:US
Practice Address - Phone:614-268-6000
Practice Address - Fax:614-267-1879
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060840S208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0806284Medicaid
OH0806284Medicaid
B09287Medicare UPIN
IN1181400001Medicare NSC