Provider Demographics
NPI:1043291404
Name:SOMANI, SUJATA (MD)
Entity type:Individual
Prefix:DR
First Name:SUJATA
Middle Name:
Last Name:SOMANI
Suffix:
Gender:F
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:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-2756
Mailing Address - Fax:617-724-0257
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 4E VINCENT OB-GYN SERVICE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2756
Practice Address - Fax:617-724-0257
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA70471207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3071049Medicaid
MAJ10615OtherBCBS MA
MA070471OtherTUFTS HEALTH PLAN
MAJ10615Medicare ID - Type Unspecified
MA3071049Medicaid