Provider Demographics
NPI:1316353873
Name:NAGARAJA, SOUMYA (MD)
Entity type:Individual
Prefix:
First Name:SOUMYA
Middle Name:
Last Name:NAGARAJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 S DOBSON RD STE B221
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-4745
Mailing Address - Country:US
Mailing Address - Phone:480-827-5370
Mailing Address - Fax:
Practice Address - Street 1:1450S DOBSONRD,
Practice Address - Street 2:STE B221
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6770
Practice Address - Country:US
Practice Address - Phone:480-827-5370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-05
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ596662080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program