Healthcare Provider Details

I. General information

NPI: 1033176466
Provider Name (Legal Business Name): JEFFREY POPMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 PILGRIM RD # BAKER4
BOSTON MA
02215-5324
US

IV. Provider business mailing address

185 PILGRIM RD
BOSTON MA
02215-5324
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-9210
  • Fax: 617-632-7460
Mailing address:
  • Phone: 617-632-9214
  • Fax: 617-632-7460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number157915
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number157915
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: