Provider Demographics
NPI:1356422778
Name:SOPHER, MARC DOUGLAS (MD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:DOUGLAS
Last Name:SOPHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 HAMPTON RD
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-4842
Mailing Address - Country:US
Mailing Address - Phone:603-772-5684
Mailing Address - Fax:603-772-5256
Practice Address - Street 1:27 HAMPTON RD
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-4842
Practice Address - Country:US
Practice Address - Phone:603-772-5684
Practice Address - Fax:603-772-5256
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8330207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30214093Medicaid
NH30214093Medicaid
NHD99798Medicare UPIN