Provider Demographics
NPI:1013242668
Name:SOFFRONOFF, ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:
Last Name:SOFFRONOFF
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 1:36315 TARPON DR
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-5056
Mailing Address - Country:US
Mailing Address - Phone:302-827-2284
Mailing Address - Fax:
Practice Address - Street 1:36315 TARPON DR
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-5056
Practice Address - Country:US
Practice Address - Phone:302-827-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008908207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC57565Medicare UPIN