Provider Demographics
NPI:1225045396
Name:SOTELO, JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:
Last Name:SOTELO
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 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:83 SOUTH ST STE 1
Practice Address - Street 2:
Practice Address - City:WARE
Practice Address - State:MA
Practice Address - Zip Code:01082-1659
Practice Address - Country:US
Practice Address - Phone:413-967-2800
Practice Address - Fax:413-967-2806
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT040549207RG0100X, 207R00000X
MA230437207RG0100X
NY001982207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026479501OtherUNIVERA HEALTHCARE
NY2217354OtherFIRST HEALTH NETWORK
NY02503771Medicaid
NY0411729OtherINDEPENDENTHEALTH IPA/WNY
NYP00151158OtherRAILROAD MEDICARE PART B
NY000527506OtherBC/BS
NY02503771Medicaid
NY00026479501OtherUNIVERA HEALTHCARE