Provider Demographics
NPI:1770726358
Name:SOROF, JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:SOROF
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 1:1800 CONCORD PIKE
Mailing Address - Street 2:D3C-124
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19850
Mailing Address - Country:US
Mailing Address - Phone:302-885-0250
Mailing Address - Fax:
Practice Address - Street 1:1800 CONCORD PIKE
Practice Address - Street 2:D3C-124
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19850
Practice Address - Country:US
Practice Address - Phone:302-885-0250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9358174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty