Provider Demographics
NPI:1932235454
Name:SOMMER, VICKI M (MD)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:M
Last Name:SOMMER
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 1:1125 OLD RTE 220 N
Mailing Address - Street 2:PO BOX 909
Mailing Address - City:DUNCANSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16635
Mailing Address - Country:US
Mailing Address - Phone:814-693-0300
Mailing Address - Fax:814-693-0400
Practice Address - Street 1:1125 OLD RTE 220 N
Practice Address - Street 2:
Practice Address - City:DUNCANSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16635
Practice Address - Country:US
Practice Address - Phone:814-693-0300
Practice Address - Fax:814-693-0400
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026769E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA465798OtherHIGHMARK
E64118Medicare UPIN