Provider Demographics
NPI:1922071620
Name:SOPHY, MATTHEW C (DO)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:SOPHY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 COAL ST
Mailing Address - Street 2:
Mailing Address - City:PORT CARBON
Mailing Address - State:PA
Mailing Address - Zip Code:17965-1823
Mailing Address - Country:US
Mailing Address - Phone:570-622-6302
Mailing Address - Fax:570-622-7153
Practice Address - Street 1:73 COAL ST
Practice Address - Street 2:
Practice Address - City:PORT CARBON
Practice Address - State:PA
Practice Address - Zip Code:17965-1823
Practice Address - Country:US
Practice Address - Phone:570-622-6302
Practice Address - Fax:570-622-7153
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005079L207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0009455300002Medicaid
PAD77413Medicare UPIN
PASO33409Medicare ID - Type Unspecified