Basic Information
| Provider Information | |||||||||
| NPI: | 1225558505 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOM | ||||||||
| FirstName: | ANIRUDDH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 GLENWOOD AVE APT 502 | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276081074 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8322874562 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | UNC NASH GENERAL HOSPITAL | ||||||||
| Address2: | 2460 CURTIS ELLIS | ||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278042780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529628000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2017 | ||||||||
| LastUpdateDate: | 08/24/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | 193400000X SINGLE SPECIALTY GROUP | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207R00000X | 2020-02074 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.