Healthcare Provider Details

I. General information

NPI: 1407815772
Provider Name (Legal Business Name): TEPPE POPOVICH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 WARSTEINER WAY APT 701
MELBOURNE BEACH FL
32951-3983
US

IV. Provider business mailing address

140 WARSTEINER WAY APT 701
MELBOURNE BEACH FL
32951-3983
US

V. Phone/Fax

Practice location:
  • Phone: 304-685-7166
  • Fax:
Mailing address:
  • Phone: 304-685-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number21553
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC158133
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2018-02760
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME106975
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: