Provider Demographics
NPI:1366506875
Name:SORKIN, HARDY LEIGH (MD)
Entity Type:Individual
Prefix:
First Name:HARDY
Middle Name:LEIGH
Last Name:SORKIN
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 1:1404 CERISSE CT
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3535
Mailing Address - Country:US
Mailing Address - Phone:610-306-4100
Mailing Address - Fax:
Practice Address - Street 1:1404 CERISSE CT
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-3535
Practice Address - Country:US
Practice Address - Phone:610-306-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014644E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012887760001Medicaid
PAB34984Medicare UPIN
PA0012887760001Medicaid