Provider Demographics
NPI:1619969789
Name:PALLEGAR, SOMASHEKAR (MD ABFP FRCS DA FPA)
Entity type:Individual
Prefix:MR
First Name:SOMASHEKAR
Middle Name:
Last Name:PALLEGAR
Suffix:
Gender:M
Credentials:MD ABFP FRCS DA FPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 BAYSHORE GARDENS PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4706
Mailing Address - Country:US
Mailing Address - Phone:941-755-9550
Mailing Address - Fax:941-755-8520
Practice Address - Street 1:1811 BAYSHORE GARDENS PKWY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4706
Practice Address - Country:US
Practice Address - Phone:941-755-9550
Practice Address - Fax:941-755-8520
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2017-02-20
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
FLME0076940207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G68662Medicare UPIN
FL44709YMedicare PIN