Provider Demographics
NPI:1336333855
Name:SOPREY, VIJAY (PA)
Entity Type:Individual
Prefix:MR
First Name:VIJAY
Middle Name:
Last Name:SOPREY
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:560L LOCH RAVEN BLVD
Mailing Address - Street 2:GSH POB 406, DEPT PM & REHAB
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239
Mailing Address - Country:US
Mailing Address - Phone:410-532-4701
Mailing Address - Fax:410-532-4719
Practice Address - Street 1:560L LOCH RAVEN BLVD
Practice Address - Street 2:GSH POB 406, DEPT PM & REHAB
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239
Practice Address - Country:US
Practice Address - Phone:410-532-4701
Practice Address - Fax:410-532-4719
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2010-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MD961845363AM0700X
MDD70201363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD177756YTLMedicare PIN