Basic Information
Provider Information | |||||||||
NPI: | 1891828125 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SORIANO | ||||||||
FirstName: | CYNTHIA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 501 FAIRMOUNT AVE STE 103 | ||||||||
Address2: |   | ||||||||
City: | TOWSON | ||||||||
State: | MD | ||||||||
PostalCode: | 212865457 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4104947921 | ||||||||
FaxNumber: | 4109028247 | ||||||||
Practice Location | |||||||||
Address1: | 515 FAIRMOUNT AVE STE 500 | ||||||||
Address2: |   | ||||||||
City: | TOWSON | ||||||||
State: | MD | ||||||||
PostalCode: | 212865466 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4104941662 | ||||||||
FaxNumber: | 4104941718 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/14/2007 | ||||||||
LastUpdateDate: | 03/10/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/01/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | D51347 | MD | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 2084S0012X | D51347 | MD | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine | 207RC0200X | D51347 | MD | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
ID | Type | State | Issuer | Description | 2110946 | 01 | MD | UNITED | OTHER | 61984601 | 01 | MD | BC BS MD | OTHER | E5540029 | 01 | MD | BLUE CHOICE | OTHER |