Provider Demographics
NPI:1760534978
Name:POPE, CHARITA (MD)
Entity Type:Individual
Prefix:MS
First Name:CHARITA
Middle Name:
Last Name:POPE
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 1:14901 BROSCHART RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3318
Mailing Address - Country:US
Mailing Address - Phone:301-251-4577
Mailing Address - Fax:202-291-2080
Practice Address - Street 1:14901 BROSCHART RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3318
Practice Address - Country:US
Practice Address - Phone:301-251-4577
Practice Address - Fax:202-291-2080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND00482992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405321400Medicaid
DC491776Medicare ID - Type UnspecifiedMEDICARE
DCUPINMedicare UPIN