Healthcare Provider Details

I. General information

NPI: 1609067016
Provider Name (Legal Business Name): SOMA PRADHAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 KENTON STATION DR
MAYSVILLE KY
41056-9617
US

IV. Provider business mailing address

PO BOX 550
VANCEBURG KY
41179-0550
US

V. Phone/Fax

Practice location:
  • Phone: 606-759-5331
  • Fax: 606-759-5363
Mailing address:
  • Phone: 606-796-3029
  • Fax: 606-796-6221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number56310
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number43329
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: