Provider Demographics
NPI:1790843076
Name:SORIA, ESTANISLAO V JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTANISLAO
Middle Name:V
Last Name:SORIA
Suffix:JR
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 1:4412 CLEVHAMM CMN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-6319
Mailing Address - Country:US
Mailing Address - Phone:757-471-3674
Mailing Address - Fax:757-471-3673
Practice Address - Street 1:1035 NIDER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2701
Practice Address - Country:US
Practice Address - Phone:757-314-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01040535207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine