Provider Demographics
NPI:1659367027
Name:TEMPLE, SOFIA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SOFIA
Middle Name:MARIE
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:800 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3300
Mailing Address - Country:US
Mailing Address - Phone:864-234-5800
Mailing Address - Fax:864-234-5881
Practice Address - Street 1:800 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3300
Practice Address - Country:US
Practice Address - Phone:864-234-5800
Practice Address - Fax:864-234-5881
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC323769Medicaid
E55301Medicare UPIN
SC323769Medicaid