Healthcare Provider Details

I. General information

NPI: 1063946846
Provider Name (Legal Business Name): JONATHAN DAVID SORAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2017
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MASON FARM RD AMBULATORY CARE CENTER
CHAPEL HILL NC
27599-6134
US

IV. Provider business mailing address

102 MASON FARM RD AMBULATORY CARE CENTER
CHAPEL HILL NC
27599-6134
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-1459
  • Fax: 919-843-2356
Mailing address:
  • Phone: 919-966-1459
  • Fax: 919-843-2356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number226973
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: