Provider Demographics
NPI:1528021946
Name:SOORI, MOHAMMED KANYORI BOYE (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:KANYORI BOYE
Last Name:SOORI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 DEVORE CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1076
Mailing Address - Country:US
Mailing Address - Phone:757-412-1156
Mailing Address - Fax:757-412-1301
Practice Address - Street 1:2232 DEVORE CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1076
Practice Address - Country:US
Practice Address - Phone:757-412-1156
Practice Address - Fax:757-412-1301
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012375352084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010149436Medicaid
VA178901OtherANTHEM BLUE CROSS
VA218064OtherMAMSI
VA218064OtherMAMSI