Healthcare Provider Details

I. General information

NPI: 1407846579
Provider Name (Legal Business Name): RICHARD I POPOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 10/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 WALNUT ST
FOXBORO MA
02035-5312
US

IV. Provider business mailing address

70 WALNUT ST
FOXBORO MA
02035-5312
US

V. Phone/Fax

Practice location:
  • Phone: 508-543-6371
  • Fax: 508-543-3347
Mailing address:
  • Phone: 508-543-6371
  • Fax: 508-543-3347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number155338
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: