MEDICARE: DR. AYORINDE SOIPE MD, MSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	98199	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207RN0300X	Nephrology Physician	98199	GA

General Provider Information

NPI Number	:	1073074167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AYORINDE SOIPE MD, MSC

Provider Business Mailing Address
First Line	:	750 E ADAMS ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-2306
Country	:	US
Telephone Number	:	315-464-3834
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 CRUSE RD STE 103
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30044-3169
Country	:	US
Telephone Number	:	470-227-8130
Fax Number	:	470-747-7588

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	01/20/2024

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