Provider Demographics
NPI:1063617173
Name:VELLAIAPPAN SOMASUNDARAM M.D. PLLC
Entity type:Organization
Organization Name:VELLAIAPPAN SOMASUNDARAM M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VELLAIAPPAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOMASUNDARAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-237-5800
Mailing Address - Street 1:306 HOSPITAL DR STE 202C
Mailing Address - Street 2:
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4096
Mailing Address - Country:US
Mailing Address - Phone:606-237-5800
Mailing Address - Fax:606-237-5858
Practice Address - Street 1:306 HOSPITAL DR STE 202C
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4096
Practice Address - Country:US
Practice Address - Phone:606-237-5800
Practice Address - Fax:606-237-5858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35436207R00000X, 261QP2300X
KY3567P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64013253Medicaid
WV600592001Medicaid
KY1891745386OtherINDIVIDUAL NPI
KY64013253Medicaid
KYHO6095Medicare UPIN