Provider Demographics
NPI:1285813774
Name:IOAN POP MD PA
Entity Type:Organization
Organization Name:IOAN POP MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:IOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-347-2161
Mailing Address - Street 1:P. O. BOX 5014
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33008-5014
Mailing Address - Country:US
Mailing Address - Phone:954-347-2125
Mailing Address - Fax:
Practice Address - Street 1:1731 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4656
Practice Address - Country:US
Practice Address - Phone:954-456-9696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME893462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty