Healthcare Provider Details

I. General information

NPI: 1710746888
Provider Name (Legal Business Name): VIKRAM SODHI MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 TOLL HOUSE AVE UNIT D3
FREDERICK MD
21701
US

IV. Provider business mailing address

14828 MERIWETHER DR
GLENELG MD
21737-9626
US

V. Phone/Fax

Practice location:
  • Phone: 240-772-5775
  • Fax: 240-772-5789
Mailing address:
  • Phone: 716-698-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VIKRAM SINGH SODHI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 716-698-2386