Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125.068434 | IL |
N | 111NI0900X | Internist | 125.068434 | IL |
NPI | 1003260456 |
---|---|
Provider Name | Dr. Sudeep Ashokkumar Soni |
First Address | Middle River, MD 21220-2004 |
Second Address | Baltimore, MD 21287-0006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2016 |
Last Update Date | 17/08/2021 |