Provider Demographics
NPI:1194835264
Name:SORENSEN, ALMA GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:ALMA
Middle Name:GREGORY
Last Name:SORENSEN
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:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - Street 2:PO BOX 9142
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:NEURORADIOLOGY
Practice Address - Street 2:55 FRUIT STREET GRB 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-3914
Practice Address - Fax:617-726-7422
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA773622085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA737778OtherTUFTS HEALTH PLAN
MA3126447Medicaid
MAJ30634OtherBCBS MA
MA3126447Medicaid
MA737778OtherTUFTS HEALTH PLAN