Healthcare Provider Details

I. General information

NPI: 1710891197
Provider Name (Legal Business Name): SOPHIE WILMANSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 PA-611 STE 300
BARTONSVILLE PA
18321
US

IV. Provider business mailing address

905 GREEN ST
LEHIGHTON PA
18235-6170
US

V. Phone/Fax

Practice location:
  • Phone: 484-526-2598
  • Fax:
Mailing address:
  • Phone: 908-305-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMA068336
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: