Provider Demographics
NPI:1104026608
Name:PUGACH, SOFYA (MD)
Entity Type:Individual
Prefix:
First Name:SOFYA
Middle Name:
Last Name:PUGACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7759 WORTHING ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6449
Mailing Address - Country:US
Mailing Address - Phone:972-250-2497
Mailing Address - Fax:
Practice Address - Street 1:8989 FOREST LN STE 146
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4159
Practice Address - Country:US
Practice Address - Phone:972-792-7777
Practice Address - Fax:972-792-7777
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA080036002083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine