Provider Demographics
NPI:1588788194
Name:SOMESHWAR, SHIV P (MD)
Entity type:Individual
Prefix:DR
First Name:SHIV
Middle Name:P
Last Name:SOMESHWAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MICHIGAN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-2916
Mailing Address - Country:US
Mailing Address - Phone:202-476-5014
Mailing Address - Fax:202-476-3732
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-5014
Practice Address - Fax:202-476-3732
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV20913208000000X
VA0101252933208000000X
DCMD040913208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC76828900Medicaid
WV1808630000Medicaid
MD510213800Medicaid
VA1588788194Medicaid
DC76828900Medicaid
MD510213800Medicaid