Healthcare Provider Details

I. General information

NPI: 1457625584
Provider Name (Legal Business Name): DIANA SOFFER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 12/24/2024
Certification Date: 12/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 STEEPLE CHASE DR STE 403
PRINCE FREDERICK MD
20678-4051
US

IV. Provider business mailing address

301 STEEPLE CHASE DR STE 403
PRINCE FREDERICK MD
20678-4051
US

V. Phone/Fax

Practice location:
  • Phone: 443-530-9424
  • Fax: 443-338-8238
Mailing address:
  • Phone: 443-530-9424
  • Fax: 443-338-8238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA112146
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberD74536
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: