Provider Demographics
NPI:1073721205
Name:SOKOLOFF, RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SOKOLOFF
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 BOSTON POST RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2719
Mailing Address - Country:US
Mailing Address - Phone:203-453-1524
Mailing Address - Fax:203-458-0926
Practice Address - Street 1:652 BOSTON POST RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2719
Practice Address - Country:US
Practice Address - Phone:203-453-1524
Practice Address - Fax:203-458-0926
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000196213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT030000196CT01OtherANTHEM BC BS OF CT
CT030000196CT01OtherANTHEM BC BS OF CT