Provider Demographics
NPI:1003080797
Name:SOPHA, SABRINA CHRISTINE (MD)
Entity Type:Individual
Prefix:DR
First Name:SABRINA
Middle Name:CHRISTINE
Last Name:SOPHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SABRINA
Other - Middle Name:CHRISTINE
Other - Last Name:WENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64478
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4478
Mailing Address - Country:US
Mailing Address - Phone:410-955-3580
Mailing Address - Fax:
Practice Address - Street 1:600 N WOLFE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0005
Practice Address - Country:US
Practice Address - Phone:410-955-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10012828208600000X
IN11014006A208600000X
MDD74145207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD056009000Medicaid
MD244370YWBMedicare PIN