Provider Demographics
NPI:1770564544
Name:POPP, JOHN W (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:W
Last Name:POPP
Suffix:
Gender:M
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:PO BOX 4376
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29240-4376
Mailing Address - Country:US
Mailing Address - Phone:803-799-4800
Mailing Address - Fax:803-256-0395
Practice Address - Street 1:2739 LAUREL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2028
Practice Address - Country:US
Practice Address - Phone:803-799-4800
Practice Address - Fax:803-256-0395
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9519207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD79853Medicare UPIN
SC095195Medicare ID - Type Unspecified
SC4000Medicare ID - Type Unspecified