MEDICARE: MS. SOPHIE JARTU MASSAQUOI MD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QD1600X	Developmental Disabilities Clinic/Center
2	343900000X	Non-emergency Medical Transport (VAN)
3	374U00000X	Home Health Aide
4	251G00000X	Community Based Hospice Care Agency
5	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205518370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SOPHIE JARTU MASSAQUOI MD

Provider Business Mailing Address
First Line	:	2402 DEEWOOD DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2255
Country	:	US
Telephone Number	:	614-966-6166
Fax Number	:

Provider Business Practice Location Address
First Line	:	2402 DEEWOOD DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-2255
Country	:	US
Telephone Number	:	614-966-6166
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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