Healthcare Provider Details

I. General information

NPI: 1861087322
Provider Name (Legal Business Name): SOPHIA ANNA THORMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2021
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2141 LAKE AVE
ASHTABULA OH
44004-3435
US

IV. Provider business mailing address

29111 CEDAR RD
MAYFIELD HEIGHTS OH
44124-4005
US

V. Phone/Fax

Practice location:
  • Phone: 440-443-0442
  • Fax: 440-755-8010
Mailing address:
  • Phone: 440-646-1600
  • Fax: 440-646-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: