Provider Demographics
NPI:1053383877
Name:SORENSEN, MARK ROBERT (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ROBERT
Last Name:SORENSEN
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 1:211 S MAIN ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CAPE MAY COURT HOUSE
Mailing Address - State:NJ
Mailing Address - Zip Code:08210-2264
Mailing Address - Country:US
Mailing Address - Phone:609-463-0800
Mailing Address - Fax:609-463-0957
Practice Address - Street 1:211 S MAIN ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2264
Practice Address - Country:US
Practice Address - Phone:609-463-0800
Practice Address - Fax:609-463-0957
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04613500207RC0000X
PAMD029027E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1053383877OtherNPI
NJ816543OtherUNITED HEALTHCARE
NJF13850OtherHELATH NET GROUP#
NJ207767OtherUSFHP
NJ0108895000OtherAMERIHEALTH
NJ1437121027OtherNPI -GROUP#
NJ1615602Medicaid
NJ000500928OtherHIGHMARK BS
NJ6004105Medicaid
NJ986151OtherHEALTH NET
NJP382636OtherOXFORD
NJ000500928OtherHIGHMARK BS
NJ439121Medicare PIN
NJ1053383877OtherNPI