Individual
IWAN PRAYOGA SOFJAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3471 5TH AVE, SUITE 910, PITTSBURGH, PA 15213-3215
(412) 692-4503
(412) 692-4515
Mailing address
3471 5TH AVE, SUITE 910, PITTSBURGH, PA 15213-3215
(412) 692-4503
(412) 692-4515
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
287280
NY
Other
Enumeration date
06/21/2012
Last updated
04/24/2017
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