Individual
MISS THAO PHUNG SOPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9000 FRANKLIN SQUARE DR, BALTIMORE, MD 21237-3901
(443) 777-7046
(443) 777-7587
Mailing address
9000 FRANKLIN SQUARE DR, BALTIMORE, MD 21237-3901
(443) 777-7046
(443) 777-7587
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C0004123
MD
363A00000X
Physician Assistant
MA054159
PA
Other
Enumeration date
11/02/2009
Last updated
11/10/2014
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