Provider Demographics
NPI:1710666862
Name:VERGADOS, SOPHIA (PA)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:VERGADOS
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:50 WESTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-3421
Mailing Address - Country:US
Mailing Address - Phone:978-935-1687
Mailing Address - Fax:
Practice Address - Street 1:1260 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1354
Practice Address - Country:US
Practice Address - Phone:603-314-1701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-08-01
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant