Provider Demographics
NPI:1275645442
Name:POPA, IOANA LIANA (MD)
Entity Type:Individual
Prefix:
First Name:IOANA
Middle Name:LIANA
Last Name:POPA
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 1:1163 WALNUT ST
Mailing Address - Street 2:OFFICE 6
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1265
Mailing Address - Country:US
Mailing Address - Phone:617-455-7192
Mailing Address - Fax:
Practice Address - Street 1:1163 WALNUT ST
Practice Address - Street 2:OFFICE 6
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1265
Practice Address - Country:US
Practice Address - Phone:617-455-7192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2234212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA38168Medicare ID - Type Unspecified