Provider Demographics
NPI:1679808885
Name:SOPCHAK, MASON MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MASON
Middle Name:MICHAEL
Last Name:SOPCHAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4185 GARRETT RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-9564
Mailing Address - Country:US
Mailing Address - Phone:607-427-6728
Mailing Address - Fax:607-844-4288
Practice Address - Street 1:5 EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:DRYDEN
Practice Address - State:NY
Practice Address - Zip Code:13053-0000
Practice Address - Country:US
Practice Address - Phone:607-844-8181
Practice Address - Fax:607-844-4288
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIL1594796204D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM