Provider Demographics
NPI:1578527438
Name:VINOGRADOVF, SOPHIA S (MD)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:S
Last Name:VINOGRADOVF
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 1:31 BELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:UPPER HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19053-7216
Mailing Address - Country:US
Mailing Address - Phone:215-364-4530
Mailing Address - Fax:
Practice Address - Street 1:9150 MARSHALL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-2217
Practice Address - Country:US
Practice Address - Phone:215-698-1442
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034440I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA411038Medicare ID - Type UnspecifiedHEALTH CARE PROVIDER