Provider Demographics
NPI:1508448150
Name:SOROKIN, ALEXANDER IVANOVICH
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:IVANOVICH
Last Name:SOROKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HEATHERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29170-2341
Mailing Address - Country:US
Mailing Address - Phone:803-465-5278
Mailing Address - Fax:
Practice Address - Street 1:JANEWAY TOWER 7TH FLOOR MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-3182
Practice Address - Fax:336-716-5168
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program