Provider Demographics
NPI:1427059021
Name:POPOVIC, CINDY MUNRO (APRN)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:MUNRO
Last Name:POPOVIC
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 INDUSTRIAL RD
Mailing Address - Street 2:STE 5
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3736
Mailing Address - Country:US
Mailing Address - Phone:508-553-3583
Mailing Address - Fax:508-634-7315
Practice Address - Street 1:100 MEDWAY RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2923
Practice Address - Country:US
Practice Address - Phone:508-634-7338
Practice Address - Fax:508-634-7315
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-03
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002532363LX0001X
MARN208893363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0705608OtherMASSHEALTH
CT004217635Medicaid