Basic Information
| Provider Information | |||||||||
| NPI: | 1023429222 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SOMMERVILLE | ||||||||
| FirstName: | ALIA | ||||||||
| MiddleName: | CELESTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O., MSC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6000 49TH ST N | ||||||||
| Address2: | NORTHSIDE HOSPITAL | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275215057 | ||||||||
| FaxNumber: | 7275215022 | ||||||||
| Practice Location | |||||||||
| Address1: | 6000 49TH ST N | ||||||||
| Address2: | NORTHSIDE HOSPITAL | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7275215057 | ||||||||
| FaxNumber: | 7275215022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2014 | ||||||||
| LastUpdateDate: | 06/30/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | UO4552 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.