Provider Demographics
NPI:1871943597
Name:SOROKA, MARGARET TEKLA (MD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:TEKLA
Last Name:SOROKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:T
Other - Last Name:SOROKA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:120 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 PARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3805
Practice Address - Country:US
Practice Address - Phone:917-504-1387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI75183-202085R0202X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program