Healthcare Provider Details

I. General information

NPI: 1508442328
Provider Name (Legal Business Name): MATTHEW THOMAS SOMERVILLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2021
Last Update Date: 06/13/2026
Certification Date: 06/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 HAZARD AVE FL 1
ENFIELD CT
06082-4520
US

IV. Provider business mailing address

1070 MAPLETON AVE
SUFFIELD CT
06078-1380
US

V. Phone/Fax

Practice location:
  • Phone: 860-930-4249
  • Fax:
Mailing address:
  • Phone: 860-930-4249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number84465
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number84465
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: