Provider Demographics
NPI:1245209428
Name:SOFIA, CARMELA A (MD FACS)
Entity Type:Individual
Prefix:
First Name:CARMELA
Middle Name:A
Last Name:SOFIA
Suffix:
Gender:F
Credentials:MD FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MILLIKEN BLVD
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02721-1623
Mailing Address - Country:US
Mailing Address - Phone:508-674-7088
Mailing Address - Fax:
Practice Address - Street 1:222 MILLIKEN BLVD
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-1623
Practice Address - Country:US
Practice Address - Phone:508-674-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74772208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3080064Medicaid
MA3080064Medicaid
MAE51547Medicare UPIN