MEDICARE: ANANDA SOM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0075466	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110239219	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1627837	OTHER	FIRST HEALTH
3	0407698	OTHER	UNITED HEALTHCARE
5	213422	OTHER	AMERIGROUP
6	244046	OTHER	AVMED
7	410972	OTHER	TUFTS HEALTH PLAN
8	P2746142	OTHER	OXFORD HEALTH INSURANCE
9	5306646	OTHER	AETNA
10	43705	OTHER	BLUE CROSS BLUE SHIELD
11	3087332	OTHER	CIGNA
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598739534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANANDA SOM MD

Provider Business Mailing Address
First Line	:	PO BOX 1921
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34697-1921
Country	:	US
Telephone Number	:	727-738-0220
Fax Number	:	727-734-7072

Provider Business Practice Location Address
First Line	:	30522 US 19 N STE 109
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-4436
Country	:	US
Telephone Number	:	727-738-0220
Fax Number	:	727-734-7072

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	05/16/2015

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Directions to “ ANANDA SOM MD” Practice Location

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