Healthcare Provider Details

I. General information

NPI: 1649263542
Provider Name (Legal Business Name): IRINA ELENA POPA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8303 DODGE ST #225
OMAHA NE
68114-4108
US

IV. Provider business mailing address

8303 DODGE ST #225
OMAHA NE
68114-4108
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-5860
  • Fax: 402-354-2350
Mailing address:
  • Phone: 402-354-5860
  • Fax: 402-354-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number22334
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: