Healthcare Provider Details

I. General information

NPI: 1649240425
Provider Name (Legal Business Name): MICHAEL J SOMERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-6129
  • Fax: 617-730-0569
Mailing address:
  • Phone: 617-355-6129
  • Fax: 617-730-0569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72816
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number72816
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: