Healthcare Provider Details

I. General information

NPI: 1356658959
Provider Name (Legal Business Name): SANTHOSH THEYYIL SOMASHEKAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2010
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 SWIFT BLVD
RICHLAND WA
99352
US

IV. Provider business mailing address

888 SWIFT BLVD
RICHLAND WA
99352-3514
US

V. Phone/Fax

Practice location:
  • Phone: 509-946-4611
  • Fax: 509-942-2185
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-942-2812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301095840
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberMD60630913
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number47568
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: