Provider Demographics
NPI:1336323609
Name:OMORO, SOPHIA A (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:A
Last Name:OMORO
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1005 BELLEFONTAINE AVE STE 125
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2893
Practice Address - Country:US
Practice Address - Phone:419-998-8244
Practice Address - Fax:419-998-8243
Is Sole Proprietor?:No
Enumeration Date:2007-12-21
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201447207Y00000X
LAMD201447207Y00000X
OH35.129523207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00237260Medicaid
LA1034509Medicaid
LA1034509Medicaid
LA4N277Medicare PIN