Healthcare Provider Details

I. General information

NPI: 1801326400
Provider Name (Legal Business Name): SAMANTHA POP MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

93 COOPER RD STE 300
VOORHEES NJ
08043-4910
US

IV. Provider business mailing address

93 COOPER RD STE 300
VOORHEES NJ
08043-4910
US

V. Phone/Fax

Practice location:
  • Phone: 609-200-0018
  • Fax: 609-200-0018
Mailing address:
  • Phone: 609-200-0018
  • Fax: 609-200-0018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number25MA10887200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10887200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number25MA10887200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: