Provider Demographics
NPI:1841385119
Name:POPA, CARMEN (MD)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:
Last Name:POPA
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 1:6975 W 130TH ST
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7821
Mailing Address - Country:US
Mailing Address - Phone:440-888-7487
Mailing Address - Fax:440-888-7532
Practice Address - Street 1:6975 W 130TH ST
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7821
Practice Address - Country:US
Practice Address - Phone:440-888-7487
Practice Address - Fax:440-888-7532
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2274453Medicaid
OH2274453Medicaid
OH4059753Medicare PIN