Healthcare Provider Details

I. General information

NPI: 1619929205
Provider Name (Legal Business Name): HUMBERTO EDUARDO SORIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 A ST
PHILADELPHIA PA
19134-1043
US

IV. Provider business mailing address

3601 A ST
PHILADELPHIA PA
19134-1043
US

V. Phone/Fax

Practice location:
  • Phone: 215-427-6781
  • Fax: 215-427-6782
Mailing address:
  • Phone: 215-427-6781
  • Fax: 215-427-6782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD-420219
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: