Healthcare Provider Details

I. General information

NPI: 1932199429
Provider Name (Legal Business Name): CHARLES WILLIAM POPPER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHARLES WILLIAM POPPER M.D.

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 CONCORD AVE SUITE 204
BELMONT MA
02478-3083
US

IV. Provider business mailing address

385 CONCORD AVE SUITE 204
BELMONT MA
02478-3083
US

V. Phone/Fax

Practice location:
  • Phone: 617-484-4408
  • Fax: 617-484-4478
Mailing address:
  • Phone: 617-484-4408
  • Fax: 617-484-4478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44333
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number44333
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: