Provider Demographics
NPI:1972544609
Name:POPA, MIRELA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:MIRELA
Middle Name:NICOLE
Last Name:POPA
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 1:675A HAMMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2117
Mailing Address - Country:US
Mailing Address - Phone:781-444-7186
Mailing Address - Fax:
Practice Address - Street 1:111 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2900
Practice Address - Country:US
Practice Address - Phone:781-444-7186
Practice Address - Fax:781-449-4617
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205292174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ22888OtherBCBS
MA205292OtherTUFTS
MA3960917OtherAETNA
MAAA16949OtherHPHC
MA0108898Medicaid
MA3960917OtherAETNA