Provider Demographics
NPI:1114912284
Name:POPP, ALBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JOHN
Last Name:POPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:R205
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-0320
Mailing Address - Fax:650-724-0220
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:R205
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-0320
Practice Address - Fax:650-724-0220
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG89161207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00510590Medicaid
NY55566EMedicare ID - Type Unspecified
NY00510590Medicaid