Provider Demographics
NPI:1891745386
Name:SOMASUNDARAM, VELLAIAPPAN (MD)
Entity Type:Individual
Prefix:DR
First Name:VELLAIAPPAN
Middle Name:
Last Name:SOMASUNDARAM
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 1:306 HOSPITAL DR STE 204
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4096
Mailing Address - Country:US
Mailing Address - Phone:606-237-5800
Mailing Address - Fax:606-237-5858
Practice Address - Street 1:306 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 202C
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503
Practice Address - Country:US
Practice Address - Phone:606-237-5800
Practice Address - Fax:606-237-5858
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35436207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6000592001OtherMEDICAID
KY64013253Medicaid
WVS0413253OtherMEDICARE
KY64013253Medicaid
H06095Medicare UPIN