MEDICARE: DR. CHARLES ANTHONY SOMA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	20-2598134	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5566654	OTHER	HI	UHA
3	192409	OTHER	HI	HMA
4	202598134	OTHER	HI	HMAA
5	4558165	OTHER	HI	AETNA
6	0000016014	OTHER	HI	HMSA
7	00D0016016	OTHER	HI	HMSA

General Provider Information

NPI Number	:	1982795118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ANTHONY SOMA M.D.

Provider Business Mailing Address
First Line	:	30 E LIPOA ST UNIT 4106
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-5821
Country	:	US
Telephone Number	:	808-242-0001
Fax Number	:	808-244-6746

Provider Business Practice Location Address
First Line	:	30 E LIPOA ST UNIT 4106
Second Line	:
City	:	KIHEI
State	:	HI
Zip	:	96753-5821
Country	:	US
Telephone Number	:	808-242-0001
Fax Number	:	808-244-6746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/04/2025

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Directions to “ DR. CHARLES ANTHONY SOMA M.D.” Practice Location

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