Healthcare Provider Details

I. General information

NPI: 1508645441
Provider Name (Legal Business Name): SOPHIA LY MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

260 TREMONT ST
BOSTON MA
02116-5603
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-1359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number3017967
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: