Provider Demographics
NPI:1003816836
Name:SOFAT, SHUBIR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUBIR
Middle Name:
Last Name:SOFAT
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 1:12013 GREAT ELM DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-1227
Mailing Address - Country:US
Mailing Address - Phone:301-610-4000
Mailing Address - Fax:301-610-4007
Practice Address - Street 1:10110 MOLECULAR DR STE 200
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7542
Practice Address - Country:US
Practice Address - Phone:301-610-4000
Practice Address - Fax:301-610-4007
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055068207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD145504400Medicaid
MD00B401M21Medicare ID - Type Unspecified
MD010653A94Medicare PIN