Healthcare Provider Details

I. General information

NPI: 1902126329
Provider Name (Legal Business Name): MR. WILLIAM CHARLES SOKOLOSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 MAIN ST
HOPE VALLEY RI
02832-1920
US

IV. Provider business mailing address

PO BOX 204
BRADFORD RI
02808-0204
US

V. Phone/Fax

Practice location:
  • Phone: 401-539-2461
  • Fax: 401-539-2676
Mailing address:
  • Phone: 401-322-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00234
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: