Healthcare Provider Details

I. General information

NPI: 1366625733
Provider Name (Legal Business Name): ROSS SOMMERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2007
Last Update Date: 07/23/2021
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 TAFT AVE
PROVIDENCE RI
02906-3406
US

IV. Provider business mailing address

14 TAFT AVE
PROVIDENCE RI
02906-3406
US

V. Phone/Fax

Practice location:
  • Phone: 401-521-1909
  • Fax:
Mailing address:
  • Phone: 401-521-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME107270
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD12520
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: