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General NPI Number Information
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NPI Number | 1386855435
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Entity Type | Individual
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Provider Name | SOMA SUNDARAM AVVA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2200 PHILADELPHIA DR 651
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City | DAYTON
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State | OH
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Zip | 45406-1840
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Country | US
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Telephone | 937-278-0809
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Fax | 937-275-2696
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Provider Business Mailing Address
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Address Line | 5770 WILLOW WALK
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City | DAYTON
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State | OH
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Zip | 45415-2620
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Country | US
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Telephone | 937-275-5600
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Fax | 937-275-2696
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0122X
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Taxonomy Name | Plastic and Reconstructive Surgery Physician
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License Number | 35.37830
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License Number State | OH
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