Healthcare Provider Details

I. General information

NPI: 1316889397
Provider Name (Legal Business Name): SOPHIA CATHERINE RODGERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W LORAIN ST STE 100
OBERLIN OH
44074-1087
US

IV. Provider business mailing address

224 W LORAIN ST STE 100
OBERLIN OH
44074-1087
US

V. Phone/Fax

Practice location:
  • Phone: 440-960-3304
  • Fax: 440-960-4733
Mailing address:
  • Phone: 440-960-3304
  • Fax: 440-960-4733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010160RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: