Provider Demographics
NPI:1740281419
Name:SOFISH, THEODORE M (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:M
Last Name:SOFISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:785 5TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:1610 ORCHARD DR
Practice Address - Street 2:OCCUPATIONAL HEALTH ASSOCIATES
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-9206
Practice Address - Country:US
Practice Address - Phone:717-261-0929
Practice Address - Fax:717-264-4969
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD046837L2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1716306OtherDEVON
PA926484OtherFIRST HEALTH
PAMD046837LOtherLICENSE
PA120420402OtherDEPT OF LABOR
PABS3491040OtherDEA