Provider Demographics
NPI:1518953264
Name:SOROKANICH, STEPHEN JR (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SOROKANICH
Suffix:JR
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 1:707 GLENBURN RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2305
Mailing Address - Country:US
Mailing Address - Phone:570-586-5909
Mailing Address - Fax:
Practice Address - Street 1:521 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9024
Practice Address - Country:US
Practice Address - Phone:570-586-3976
Practice Address - Fax:570-585-2903
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036397E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA75788Medicaid
433684Medicare ID - Type Unspecified
PA75788Medicaid