Basic Information
| Provider Information | |||||||||
| NPI: | 1740281419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SOFISH | ||||||||
| FirstName: | THEODORE | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 785 5TH AVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172014232 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172639555 | ||||||||
| FaxNumber: | 7172174217 | ||||||||
| Practice Location | |||||||||
| Address1: | 1610 ORCHARD DR | ||||||||
| Address2: | OCCUPATIONAL HEALTH ASSOCIATES | ||||||||
| City: | CHAMBERSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 172019206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7172610929 | ||||||||
| FaxNumber: | 7172644969 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2005 | ||||||||
| LastUpdateDate: | 03/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | MD046837L | PA | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine |
ID Information
| ID | Type | State | Issuer | Description | 25-1716306 | 01 | PA | DEVON | OTHER | 926484 | 01 | PA | FIRST HEALTH | OTHER | MD046837L | 01 | PA | LICENSE | OTHER | 120420402 | 01 | PA | DEPT OF LABOR | OTHER | BS3491040 | 01 | PA | DEA | OTHER |