Provider Demographics
NPI:1407846579
Name:POPOVIC, RICHARD I (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:I
Last Name:POPOVIC
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 1:70 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-5312
Mailing Address - Country:US
Mailing Address - Phone:508-543-6371
Mailing Address - Fax:508-543-3347
Practice Address - Street 1:70 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-5312
Practice Address - Country:US
Practice Address - Phone:508-543-6371
Practice Address - Fax:508-543-3347
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155338207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3183548Medicaid
G72578Medicare UPIN
MAA28514Medicare ID - Type Unspecified