Provider Demographics
NPI:1932199429
Name:POPPER, CHARLES WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:POPPER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLES
Other - Middle Name:WILLIAM
Other - Last Name:POPPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:385 CONCORD AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3083
Mailing Address - Country:US
Mailing Address - Phone:617-484-4408
Mailing Address - Fax:617-484-4478
Practice Address - Street 1:385 CONCORD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3083
Practice Address - Country:US
Practice Address - Phone:617-484-4408
Practice Address - Fax:617-484-4478
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA443332084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA44333OtherSTATE MEDICAL LICENSE
MAAP8685109OtherDEA NUMBER
MAA31916Medicare UPIN
MAB 07176Medicare ID - Type Unspecified