Provider Demographics
NPI:1396485819
Name:RAFFERTY, SOPHIA THERESA (DO)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:THERESA
Last Name:RAFFERTY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1540 E. HOSPITAL DRIVE
Mailing Address - Street 2:CW 8-641, SPC 4254
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-4254
Mailing Address - Country:US
Mailing Address - Phone:734-936-4213
Mailing Address - Fax:
Practice Address - Street 1:1540 E. HOSPITAL DRIVE
Practice Address - Street 2:CW 8-641, SPC 4254
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-4254
Practice Address - Country:US
Practice Address - Phone:734-936-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010284572080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine