Provider Demographics
NPI:1023009271
Name:SOFI, UMAR (MD)
Entity Type:Individual
Prefix:
First Name:UMAR
Middle Name:
Last Name:SOFI
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 1:2001 CRYSTAL SPRING AVE SW STE 300
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2465
Mailing Address - Country:US
Mailing Address - Phone:540-985-8505
Mailing Address - Fax:540-344-3313
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW STE 300
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2465
Practice Address - Country:US
Practice Address - Phone:540-985-8505
Practice Address - Fax:540-344-3313
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237593207RP1001X
GA063027207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I291057OtherMEDICARE PTAN
GA202I291057OtherMEDICARE PTAN