Provider Demographics
NPI:1881641132
Name:SOKOLOFF, KEITH R (DO)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:R
Last Name:SOKOLOFF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:360 MOURNING DOVE DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-4124
Mailing Address - Country:US
Mailing Address - Phone:302-509-1679
Mailing Address - Fax:443-593-3060
Practice Address - Street 1:14 ROGERS RD
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:MD
Practice Address - Zip Code:21901
Practice Address - Country:US
Practice Address - Phone:410-392-3694
Practice Address - Fax:443-593-3060
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC2-0010313207Q00000X
MDH76273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H50328Medicare UPIN