Organization
SHANE M SOPP, MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE M SOPP MD (OWNER)
(315) 492-5005
Entity
Organization
Contact information
Practice address
4900 BROAD RD, CGH POB SUITE 2V, SYRACUSE, NY 13215-2265
(315) 492-5005
(315) 492-5324
Mailing address
PO BOX 2003, EAST SYRACUSE, NY 13057-4503
(315) 446-3904
(315) 445-2936
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01992896
—
NY
Enumeration date
09/26/2005
Last updated
02/07/2008
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