Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | AJ414735 | MD |
NPI | 1013283472 |
---|---|
Provider Name | Dr. Nikolai Sopko |
First Address | Baltimore, MD 21287-0005 |
Second Address | Baltimore, MD 21287-0005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 12/08/2015 |