Provider Demographics
NPI:1407815772
Name:POPOVICH, TEPPE (MD)
Entity type:Individual
Prefix:DR
First Name:TEPPE
Middle Name:
Last Name:POPOVICH
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 1:140 WARSTEINER WAY APT 701
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3983
Mailing Address - Country:US
Mailing Address - Phone:304-685-7166
Mailing Address - Fax:
Practice Address - Street 1:140 WARSTEINER WAY APT 701
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-3983
Practice Address - Country:US
Practice Address - Phone:304-685-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV215532085R0202X
CAC1581332085R0202X
NC2018-027602085R0202X
FLME1069752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002344Medicaid
WV3810002344Medicaid
I32383Medicare UPIN