Provider Demographics
NPI:1255374864
Name:SOMERS, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SOMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 PARKWAY SOUTH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-443-4383
Mailing Address - Fax:860-443-3980
Practice Address - Street 1:196 PARKWAY SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-443-4383
Practice Address - Fax:860-443-3980
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT39440207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
0V8893OtherHEALTHNET/ECCG:06-1049086
010039440CT03OtherANTHEM/ECCD:06-1616101
060063797OtherRR MED/ECCG:06-1049086
001394402OtherBLUECARE FAMILY PLAN
CT001394402Medicaid
060064823OtherRR MED/ECCD:06-1616101
P2524336OtherOXFORD/ECCD:06-1616101
010039440CT01OtherANTHEM/ECCG: 06-1049086
0V7317OtherHEALTHNET/ECCD:06-1616101
P2375792OtherOXFORD/ECCG:06-1049086
038610OtherCONNECTICARE
500HBC444CT01OtherANTHEM:HOSP-BASED ECCD
010039440CT03OtherANTHEM/ECCD:06-1616101
060001404Medicare ID - Type UnspecifiedECCG: 06-1049086
060063797OtherRR MED/ECCG:06-1049086