Healthcare Provider Details

I. General information

NPI: 1770784209
Provider Name (Legal Business Name): JUSTINE J. SOMOZA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PARKWAY SUITE 306
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

2000 MEDICAL PARKWAY SUITE 306
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 410-571-9700
  • Fax: 410-571-9710
Mailing address:
  • Phone: 410-571-9700
  • Fax: 410-571-9710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0076622
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: