Provider Demographics
NPI:1467748111
Name:SO, SOKPOLEAK (MD)
Entity Type:Individual
Prefix:
First Name:SOKPOLEAK
Middle Name:
Last Name:SO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11350 MCCORMICK RD
Mailing Address - Street 2:EXECUTIVE PLAZA 1, SUITE 501
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031
Mailing Address - Country:US
Mailing Address - Phone:410-329-1071
Mailing Address - Fax:410-329-1054
Practice Address - Street 1:67 SAND PIT RD
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-743-7264
Practice Address - Fax:203-792-3920
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2018-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT55481208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology