Provider Demographics
NPI:1225897176
Name:SOCHA, EDWARD NICHOLAS (PA-C)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:NICHOLAS
Last Name:SOCHA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 CHURCH ST UNIT 509
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3022
Mailing Address - Country:US
Mailing Address - Phone:202-492-2600
Mailing Address - Fax:
Practice Address - Street 1:109 CHURCH ST UNIT 509
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3022
Practice Address - Country:US
Practice Address - Phone:202-492-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY032316363A00000X
MAPA100867363A00000X
CT23.006666363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT23.006666OtherSTATE OF CONNECTICUT
MAPA100867OtherCOMMONWEALTH OF MASSACHUSETTS