Provider Demographics
NPI:1780022236
Name:SOROKIN, JEFFREY ALAN (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:ALAN
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 1:594 GREAT RD
Mailing Address - Street 2:SUITE 102A
Mailing Address - City:NORTH SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02896-6810
Mailing Address - Country:US
Mailing Address - Phone:401-768-3400
Mailing Address - Fax:401-768-3402
Practice Address - Street 1:594 GREAT RD
Practice Address - Street 2:SUITE 102A
Practice Address - City:NORTH SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02896-6810
Practice Address - Country:US
Practice Address - Phone:401-768-3400
Practice Address - Fax:401-768-3402
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD15343207Q00000X
RILP02879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RES000Medicare UPIN