Provider Demographics
NPI:1023001484
Name:NORMAN, SOENDA P (MD)
Entity Type:Individual
Prefix:MRS
First Name:SOENDA
Middle Name:P
Last Name:NORMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOENDA
Other - Middle Name:E
Other - Last Name:PADMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5213 S ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:919-620-4921
Practice Address - Street 1:10211 ALM ST
Practice Address - Street 2:SUITE 1200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-8221
Practice Address - Country:US
Practice Address - Phone:919-206-4889
Practice Address - Fax:919-206-4875
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD11651207Q00000X
NC2012-01463207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920580Medicaid
NCNC7475AMedicare PIN