Provider Demographics
NPI:1700858404
Name:SOOS, TAMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMAS
Middle Name:
Last Name:SOOS
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:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-0249
Mailing Address - Country:US
Mailing Address - Phone:336-679-4963
Mailing Address - Fax:336-679-2549
Practice Address - Street 1:640 PARKWOOD MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2487
Practice Address - Country:US
Practice Address - Phone:336-526-7997
Practice Address - Fax:336-526-3537
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200001437207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA6462OtherMEDCOST
NC128KNOtherBCBS OF NC
NC2151909OtherUNITED HEALTHCARE
NC89128KNMedicaid
NC42110OtherPARTNERS
NC7815291OtherAETNA
NC42110OtherPARTNERS
NC89128KNMedicaid