Provider Demographics
NPI:1801871835
Name:SOMESAN, ANDY (MD)
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:SOMESAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ANDY
Other - Middle Name:K
Other - Last Name:SOMESAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 17567
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32522-7567
Mailing Address - Country:US
Mailing Address - Phone:850-469-7406
Mailing Address - Fax:850-437-8283
Practice Address - Street 1:1000 W MORENO ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501
Practice Address - Country:US
Practice Address - Phone:850-469-7406
Practice Address - Fax:850-437-8283
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL18847207RG0300X
FLME79362208M00000X
FLME0079362207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258344500Medicaid
FL59149140OtherBSAL
FL49786OtherBSFL
FL5321328OtherAETNA
FL59149140OtherBSAL