Provider Demographics
NPI:1982795118
Name:SOMA, CHARLES ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:SOMA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1827 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2370
Mailing Address - Country:US
Mailing Address - Phone:808-242-0001
Mailing Address - Fax:808-244-6746
Practice Address - Street 1:1827 WELLS ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2370
Practice Address - Country:US
Practice Address - Phone:808-242-0001
Practice Address - Fax:808-244-6746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20-2598134207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000016014OtherHMSA
HI5566654OtherUHA
HI202598134OtherHMAA
HI00D0016016OtherHMSA
HI192409OtherHMA
HI01494804Medicaid
HI4558165OtherAETNA
HI0000BDWCNMedicare ID - Type Unspecified
HI192409OtherHMA