Provider Demographics
NPI:1619960325
Name:SOROKIN, EVAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:S
Last Name:SOROKIN
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 1:1734 MARLTON PIKE EAST
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003
Mailing Address - Country:US
Mailing Address - Phone:856-797-0202
Mailing Address - Fax:856-751-7700
Practice Address - Street 1:1734 MARLTON PIKE EAST
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003
Practice Address - Country:US
Practice Address - Phone:856-797-0202
Practice Address - Fax:856-751-7700
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA075414002086S0122X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0061671Medicaid
070155Medicare ID - Type Unspecified
NJH85489Medicare UPIN