Provider Demographics
NPI:1558354662
Name:SORARUF, L. PETER (MD)
Entity Type:Individual
Prefix:
First Name:L. PETER
Middle Name:
Last Name:SORARUF
Suffix:
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 1:687 UNIONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-1736
Mailing Address - Country:US
Mailing Address - Phone:610-444-2002
Mailing Address - Fax:610-444-4469
Practice Address - Street 1:687 UNIONVILLE RD
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-1736
Practice Address - Country:US
Practice Address - Phone:610-444-2002
Practice Address - Fax:610-444-4469
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-24
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018839E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093105OtherMEDICARE PTAN
PA00054334Medicaid
PA070692UGDMedicare PIN
PAC28940Medicare UPIN