Provider Demographics
NPI:1780751289
Name:HOMAFAR, SOGHRA (MD)
Entity type:Individual
Prefix:
First Name:SOGHRA
Middle Name:
Last Name:HOMAFAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4923 BAYSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224
Mailing Address - Country:US
Mailing Address - Phone:330-655-5888
Mailing Address - Fax:
Practice Address - Street 1:401 DEVON PL
Practice Address - Street 2:SUITE 210
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6482
Practice Address - Country:US
Practice Address - Phone:330-676-9465
Practice Address - Fax:330-677-4066
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-073775207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2079352Medicaid
OH2079352Medicaid
OHG82318Medicare UPIN