Healthcare Provider Details

I. General information

NPI: 1922071620
Provider Name (Legal Business Name): MATTHEW C SOPHY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 COAL ST
PORT CARBON PA
17965-1823
US

IV. Provider business mailing address

73 COAL ST
PORT CARBON PA
17965-1823
US

V. Phone/Fax

Practice location:
  • Phone: 570-622-6302
  • Fax: 570-622-7153
Mailing address:
  • Phone: 570-622-6302
  • Fax: 570-622-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberOS005079L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: