Provider Demographics
NPI:1194932897
Name:SORATHIA, DIVYANG (MD)
Entity type:Individual
Prefix:
First Name:DIVYANG
Middle Name:
Last Name:SORATHIA
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 1:500 VONDERBURG DR
Mailing Address - Street 2:EAST TOWER, SUITE 201E
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5964
Mailing Address - Country:US
Mailing Address - Phone:813-655-1100
Mailing Address - Fax:813-655-1140
Practice Address - Street 1:500 VONDERBURG DR
Practice Address - Street 2:EAST TOWER, SUITE 201E
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5964
Practice Address - Country:US
Practice Address - Phone:813-655-1100
Practice Address - Fax:813-655-1140
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 106853207RP1001X
NY2331431207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02900223Medicaid
NC5908958Medicaid
NCP00725393OtherRR MEDICARE
NC2022052Medicare PIN
NY60E11ZQQQ1Medicare PIN