Provider Demographics
NPI:1093731721
Name:MYRNA L. SORIANO MD PA
Entity Type:Organization
Organization Name:MYRNA L. SORIANO MD PA
Other - Org Name:COMPREHENSIVE METABOLISM AND MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATION PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-630-1361
Mailing Address - Street 1:1361 BRENTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3924
Mailing Address - Country:US
Mailing Address - Phone:215-497-0669
Mailing Address - Fax:215-550-6115
Practice Address - Street 1:1205 NEWTOWN LANGHORNE ROAD SUITE 406
Practice Address - Street 2:ST MARY MEDICAL OFFICE
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-630-1361
Practice Address - Fax:215-550-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA122992OtherMEDICARE PTAN