Provider Demographics
NPI:1548241086
Name:SORIANO, MARIA R (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:R
Last Name:SORIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 3RD ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4611
Mailing Address - Country:US
Mailing Address - Phone:540-857-9700
Mailing Address - Fax:540-857-9700
Practice Address - Street 1:4040 POSTAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6438
Practice Address - Country:US
Practice Address - Phone:540-772-4453
Practice Address - Fax:540-772-4717
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15221208000000X
VA0101242281208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00117933Medicaid
MS00117933Medicaid
VA017008K07Medicare PIN
MS370000238Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER