Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 0101237593 | VA |
NPI | 1023009271 |
---|---|
Provider Name | Umar Sofi |
First Address | Roanoke, VA 24014-2465 |
Second Address | Roanoke, VA 24014-2465 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 07/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
202I291057 | MEDICARE PTAN (01) | GA |
H37220 | (02) | VA |