Provider Demographics
NPI:1700815255
Name:SOPHAR, KAY (CNFP)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:
Last Name:SOPHAR
Suffix:
Gender:F
Credentials:CNFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 UNIVERSITY BLVD W
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1948
Mailing Address - Country:US
Mailing Address - Phone:301-592-1784
Mailing Address - Fax:301-592-1783
Practice Address - Street 1:344 UNIVERSITY BLVD W
Practice Address - Street 2:SUITE 213
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1948
Practice Address - Country:US
Practice Address - Phone:301-592-1784
Practice Address - Fax:301-592-1783
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR091062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD61948901OtherCFBCBS MD
MD58208OtherAMERIGROUP