Provider Demographics
NPI:1265559785
Name:SOKOLIC, LARRY J (MD)
Entity type:Individual
Prefix:MR
First Name:LARRY
Middle Name:J
Last Name:SOKOLIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22 HATFORD ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1891
Mailing Address - Country:US
Mailing Address - Phone:218-463-1365
Mailing Address - Fax:218-463-4712
Practice Address - Street 1:22 HATFORD ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1891
Practice Address - Country:US
Practice Address - Phone:218-463-1365
Practice Address - Fax:218-463-4712
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA063626207R00000X
MN56427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA063626OtherSTATE LICENSE
NJMA063626OtherSTATE LICENSE