Provider Demographics
NPI:1245268945
Name:SORNBERGER, KRIS S (DO)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:S
Last Name:SORNBERGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:S
Other - Last Name:SORNBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 CUMBERLAND PL STE 112
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5083
Mailing Address - Country:US
Mailing Address - Phone:207-307-0816
Mailing Address - Fax:207-637-1072
Practice Address - Street 1:1 CUMBERLAND PL STE 112
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5083
Practice Address - Country:US
Practice Address - Phone:207-307-0816
Practice Address - Fax:207-637-1072
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1872204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432502599Medicaid
MEMM9086Medicare PIN
MEMM9086Medicare UPIN