Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | MD21694 | DC |
NPI | 1104907088 |
---|---|
Provider Name | Mark D Sorrentino |
First Address | Washington, DC 20010-2978 |
Second Address | Washington, DC 20010-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
024450900 | (05) | DC |
102700000 | (05) | MD |
6720749 | (05) | VA |
H01290 | (02) |