Provider Demographics
NPI:1225558505
Name:SOM, ANIRUDDH (MD)
Entity type:Individual
Prefix:DR
First Name:ANIRUDDH
Middle Name:
Last Name:SOM
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GLENWOOD AVE APT 502
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-1074
Mailing Address - Country:US
Mailing Address - Phone:832-287-4562
Mailing Address - Fax:
Practice Address - Street 1:UNC NASH GENERAL HOSPITAL
Practice Address - Street 2:2460 CURTIS ELLIS
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2780
Practice Address - Country:US
Practice Address - Phone:252-962-8000
Practice Address - Fax:252-962-3320
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-02074207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty