Basic Information
| Provider Information | |||||||||
| NPI: | 1265562706 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SODERLUND | ||||||||
| FirstName: | INGRID | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 BROADWAY STREET | ||||||||
| Address2: | SOMMERVILLE ADULT MEDICINE | ||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172847000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 300 BROADWAY STREET | ||||||||
| Address2: | SOMMERVILLE ADULT MEDICINE | ||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172847000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2007 | ||||||||
| LastUpdateDate: | 01/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 75566 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.