Provider Demographics
NPI:1316267222
Name:GOVOROV, SOPHIA MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:MARIE
Last Name:GOVOROV
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1412 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2908
Mailing Address - Country:US
Mailing Address - Phone:215-599-4851
Mailing Address - Fax:215-232-4093
Practice Address - Street 1:400 W ALLEGHENY AVENUE
Practice Address - Street 2:UNITE B-5
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19133
Practice Address - Country:US
Practice Address - Phone:215-207-0522
Practice Address - Fax:215-291-2582
Is Sole Proprietor?:No
Enumeration Date:2010-06-03
Last Update Date:2021-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA053247363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant