Provider Demographics
NPI:1104806314
Name:SOROFF, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SOROFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-7616
Mailing Address - Country:US
Mailing Address - Phone:207-753-3900
Mailing Address - Fax:207-753-3902
Practice Address - Street 1:60 HIGH ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-7616
Practice Address - Country:US
Practice Address - Phone:207-753-3900
Practice Address - Fax:207-753-3902
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016701207RC0001X, 207RC0000X
KYC2677207RC0001X
VA0101274192207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEI24227Medicare UPIN
MEME1116Medicare ID - Type Unspecified