Provider Demographics
NPI:1821011032
Name:POPP, GABRIELE (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIELE
Middle Name:
Last Name:POPP
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 1:394 SKYLINE DRIVE
Mailing Address - Street 2:
Mailing Address - City:WEATHERSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156
Mailing Address - Country:US
Mailing Address - Phone:802-885-2924
Mailing Address - Fax:
Practice Address - Street 1:394 SKYLINE DRIVE
Practice Address - Street 2:
Practice Address - City:WEATHERSFIELD
Practice Address - State:VT
Practice Address - Zip Code:05156
Practice Address - Country:US
Practice Address - Phone:802-885-2924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH11220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30201350Medicaid
VT0RE6227Medicaid
443841Medicare UPIN
VT0RE6227Medicaid