Provider Demographics
NPI:1184645228
Name:SOROSKY, SUSAN C (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:C
Last Name:SOROSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N 24TH ST
Mailing Address - Street 2:STE 210
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6534
Mailing Address - Country:US
Mailing Address - Phone:602-840-0681
Mailing Address - Fax:602-957-1570
Practice Address - Street 1:3700 N 24TH ST
Practice Address - Street 2:STE 210
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6534
Practice Address - Country:US
Practice Address - Phone:602-840-0681
Practice Address - Fax:602-957-1570
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33706208100000X, 2081P2900X, 2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ130454Medicare PIN
104674Medicare ID - Type Unspecified