Provider Demographics
NPI:1598771115
Name:POPE, JONATHAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:G
Last Name:POPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PHILADELPHIA DR
Mailing Address - Street 2:SUITE 644
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1840
Mailing Address - Country:US
Mailing Address - Phone:937-278-6874
Mailing Address - Fax:937-278-7201
Practice Address - Street 1:30 E APPLE ST STE 6221
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2939
Practice Address - Country:US
Practice Address - Phone:937-208-6630
Practice Address - Fax:937-208-6641
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-425022207RI0200X
OH35.127256207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010996280001Medicaid
OH0150943Medicaid
PA001637630OtherBLUE CROSS
OHH267840Medicare PIN
PAI18465Medicare UPIN
PA001637630OtherBLUE CROSS