Provider Demographics
NPI:1104271840
Name:SOH, JONATHAN MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MATTHEW
Last Name:SOH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:505 BEAHAN RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3403
Mailing Address - Country:US
Mailing Address - Phone:585-877-6647
Mailing Address - Fax:585-877-6648
Practice Address - Street 1:505 BEAHAN RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-3403
Practice Address - Country:US
Practice Address - Phone:716-755-6647
Practice Address - Fax:716-755-6648
Is Sole Proprietor?:No
Enumeration Date:2016-05-02
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY290940207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology