Provider Demographics
NPI:1992891089
Name:SOROURI, PARVIZ (MD)
Entity type:Individual
Prefix:DR
First Name:PARVIZ
Middle Name:
Last Name:SOROURI
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 1:10 DARWIN DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-6658
Mailing Address - Country:US
Mailing Address - Phone:302-453-9171
Mailing Address - Fax:302-453-0732
Practice Address - Street 1:10 DARWIN DR
Practice Address - Street 2:SUITE C
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19711-6658
Practice Address - Country:US
Practice Address - Phone:302-453-9171
Practice Address - Fax:302-453-0732
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10001760174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000258301Medicaid
DEB66353Medicare UPIN
DE0000258301Medicaid