Provider Demographics
NPI:1902879513
Name:POPA, THOMAS O (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:O
Last Name:POPA
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 1:7426 JAGER CT
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-4344
Mailing Address - Country:US
Mailing Address - Phone:513-231-2006
Mailing Address - Fax:513-624-2994
Practice Address - Street 1:7426 JAGER CT
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-4344
Practice Address - Country:US
Practice Address - Phone:513-231-2006
Practice Address - Fax:513-624-2994
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.044390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0452559Medicaid
OHA79849Medicare UPIN