Provider Demographics
NPI:1740923515
Name:POPOV, JELENA (MB, BCH, BAO)
Entity type:Individual
Prefix:MISS
First Name:JELENA
Middle Name:
Last Name:POPOV
Suffix:
Gender:F
Credentials:MB, BCH, BAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 OAKLAND DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L8E 3R4
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE., BOSTON CHILDREN'S HOSPITAL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program