Provider Demographics
NPI:1235120700
Name:WHAP PA
Entity Type:Organization
Organization Name:WHAP PA
Other - Org Name:HERBERT A SOPER MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-768-1180
Mailing Address - Street 1:1901 S HAWTHORNE RD
Mailing Address - Street 2:STE 320
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3921
Mailing Address - Country:US
Mailing Address - Phone:336-768-1180
Mailing Address - Fax:336-768-8053
Practice Address - Street 1:1901 S HAWTHORNE RD
Practice Address - Street 2:STE 320
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3921
Practice Address - Country:US
Practice Address - Phone:336-768-1180
Practice Address - Fax:336-768-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15372207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8978410Medicaid
C80554Medicare UPIN
NC8978410Medicaid