Provider Demographics
NPI:1851379341
Name:CHRISTOPHER T SOPRENUK MD PA
Entity Type:Organization
Organization Name:CHRISTOPHER T SOPRENUK MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SOPRENUK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:352-728-1886
Mailing Address - Street 1:9846 US HIGHWAY 441
Mailing Address - Street 2:SAME
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-3910
Mailing Address - Country:US
Mailing Address - Phone:352-728-1886
Mailing Address - Fax:352-728-1024
Practice Address - Street 1:9846 US HIGHWAY 441
Practice Address - Street 2:SAME
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-3910
Practice Address - Country:US
Practice Address - Phone:352-728-1886
Practice Address - Fax:352-728-1024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2007-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5007Medicare PIN