Provider Demographics
NPI:1134109705
Name:SODEN, DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:SODEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E UNION AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1713
Mailing Address - Country:US
Mailing Address - Phone:732-560-0490
Mailing Address - Fax:732-560-3681
Practice Address - Street 1:101 E UNION AVE
Practice Address - Street 2:
Practice Address - City:BOUND BROOK
Practice Address - State:NJ
Practice Address - Zip Code:08805-1713
Practice Address - Country:US
Practice Address - Phone:732-560-0490
Practice Address - Fax:732-560-3681
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA5028300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E23803Medicare UPIN
50573417ACPMedicare ID - Type Unspecified
459807Medicare ID - Type Unspecified