1265559785 NPI number — MR. LARRY J SOKOLIC MD

Table of content: MR. LARRY J SOKOLIC MD (NPI 1265559785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265559785 NPI number — MR. LARRY J SOKOLIC MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOKOLIC
Provider First Name:
LARRY
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265559785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 HATFORD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOULTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04730-1891
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-463-1365
Provider Business Mailing Address Fax Number:
218-463-4712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 HATFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOULTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04730-1891
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-463-1365
Provider Business Practice Location Address Fax Number:
218-463-4712
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  MA063626 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 56427 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MA063626 . This is a "STATE LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com