Healthcare Provider Details

I. General information

NPI: 1205821410
Provider Name (Legal Business Name): CHARLES A SOMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 SOUTH ST
SOUTHBRIDGE MA
01550-4000
US

IV. Provider business mailing address

94 SOUTH ST
SOUTHBRIDGE MA
01550-4000
US

V. Phone/Fax

Practice location:
  • Phone: 508-764-2772
  • Fax: 508-764-2833
Mailing address:
  • Phone: 508-764-2772
  • Fax: 508-764-2833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number159558
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number159558
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: