Provider Demographics
NPI:1659321016
Name:SOSIC, ABAZ (MD)
Entity Type:Individual
Prefix:
First Name:ABAZ
Middle Name:
Last Name:SOSIC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 BOYLSTON STREET
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701
Mailing Address - Country:US
Mailing Address - Phone:814-362-9733
Mailing Address - Fax:814-362-9556
Practice Address - Street 1:54 BOYLSTON STREET
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-362-9733
Practice Address - Fax:814-362-9556
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD069319L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017963810001Medicaid
H13810Medicare UPIN
PA037064Medicare PIN