Basic Information
| Provider Information | |||||||||
| NPI: | 1184650590 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOPHER | ||||||||
| FirstName: | SHARI | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 UPPER CHESAPEAKE DR | ||||||||
| Address2: | SUITE 518 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436434530 | ||||||||
| FaxNumber: | 4436434535 | ||||||||
| Practice Location | |||||||||
| Address1: | 510 UPPER CHESAPEAKE DR | ||||||||
| Address2: | STE 518 | ||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210144328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4436434530 | ||||||||
| FaxNumber: | 4436434535 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2006 | ||||||||
| LastUpdateDate: | 12/14/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | D0036164 | MD | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 543321500 | 05 | MD | MEDICAID |