MEDICARE: MRS. SOPHIA S VINOGRADOVF M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	MD034440I	PA

General Provider Information

NPI Number	:	1578527438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SOPHIA S VINOGRADOVF M.D.

Provider Business Mailing Address
First Line	:	31 BELLWOOD DR
Second Line	:
City	:	UPPER HOLLAND
State	:	PA
Zip	:	19053-7216
Country	:	US
Telephone Number	:	215-364-4530
Fax Number	:

Provider Business Practice Location Address
First Line	:	9150 MARSHALL ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2217
Country	:	US
Telephone Number	:	215-698-1442
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2006
Last Update Date	:	07/08/2007

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