Healthcare Provider Details

I. General information

NPI: 1174917082
Provider Name (Legal Business Name): RAEANNA POPLUS SIMCOE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RAEANNA LEE POPLUS

II. Dates (important events)

Enumeration Date: 03/28/2015
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LEW DEWITT BLVD STE A
WAYNESBORO VA
22980-1663
US

IV. Provider business mailing address

PO BOX 388
FISHERSVILLE VA
22939-0388
US

V. Phone/Fax

Practice location:
  • Phone: 540-245-7940
  • Fax: 540-245-7941
Mailing address:
  • Phone: 540-332-5168
  • Fax: 540-332-5875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101274465
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: