Provider Demographics
NPI:1043321961
Name:SOTOMAYOR, ANTONIO E (MD)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:E
Last Name:SOTOMAYOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 CENTRE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19601-1458
Mailing Address - Country:US
Mailing Address - Phone:610-898-1200
Mailing Address - Fax:
Practice Address - Street 1:1220 CENTRE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19601-1458
Practice Address - Country:US
Practice Address - Phone:610-898-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030233E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA677878Medicare ID - Type Unspecified