Healthcare Provider Details

I. General information

NPI: 1104806314
Provider Name (Legal Business Name): DANIEL SOROFF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 11/13/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 HIGH ST
LEWISTON ME
04240-7616
US

IV. Provider business mailing address

60 HIGH ST
LEWISTON ME
04240-7616
US

V. Phone/Fax

Practice location:
  • Phone: 207-753-3900
  • Fax: 207-753-3902
Mailing address:
  • Phone: 207-753-3900
  • Fax: 207-753-3902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number016701
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number016701
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberC2677
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number0101274192
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: