Provider Demographics
NPI:1629523220
Name:POPE, RODERICK DAVID
Entity Type:Individual
Prefix:
First Name:RODERICK
Middle Name:DAVID
Last Name:POPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 MARION AVE # PVT
Mailing Address - Street 2:PVT. HOUSE
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552-3712
Mailing Address - Country:US
Mailing Address - Phone:914-403-2649
Mailing Address - Fax:914-371-7633
Practice Address - Street 1:67 MARION AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3712
Practice Address - Country:US
Practice Address - Phone:914-403-2649
Practice Address - Fax:914-371-7633
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY344600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi