Provider Demographics
NPI:1609010271
Name:SRORN, SOKPHEARY (MD)
Entity Type:Individual
Prefix:DR
First Name:SOKPHEARY
Middle Name:
Last Name:SRORN
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 1:7190 CRESTWOOD BLVD
Mailing Address - Street 2:KAISER PERMANENTE FREDERICK MEDICAL CENTER
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-7314
Mailing Address - Country:US
Mailing Address - Phone:800-777-7904
Mailing Address - Fax:
Practice Address - Street 1:7190 CRESTWOOD BLVD
Practice Address - Street 2:KAISER PERMANENTE FREDERICK MEDICAL CENTER
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-7314
Practice Address - Country:US
Practice Address - Phone:800-777-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101253049207Q00000X
MDD0074996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine