Popovich, Mark J
Popovich, Mark J is an individual health care provider with primary practice located at 3883 Airway Dr Ste 100 , Santa Rosa CA 95403-1672. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Body Imaging, Allopathic & Osteopathic Physicians / Nuclear Radiology, Allopathic & Osteopathic Physicians / Diagnostic Ultrasound, Allopathic & Osteopathic Physicians / Diagnostic Radiology. Allopathic & Osteopathic Physicians / Diagnostic Radiology is his primary health care specialty. Popovich, Mark J can be contacted via phone (707) 521-4480.Contact Information
Primary practice address
3883 Airway Dr Ste 100
Santa Rosa CA 95403-1672
Phone: (707) 521-4480
Fax: (707) 521-4460
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Body Imaging | 2085B0100X | G57995 | California |
Allopathic & Osteopathic Physicians / Nuclear Radiology | 2085N0904X | G57995 | California |
Allopathic & Osteopathic Physicians / Diagnostic Ultrasound | 2085U0001X | G57995 | California |
Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | G57995 | California |
Profile Details
NPI number | 1245320704 |
---|---|
LBN Legal business name | Popovich, Mark J |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Oct 13th, 2006 |
Last updated | Aug 26th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1245320704 | NPPES |
California | MEDICAID | 00G579950 | |
California | Other | 473423 | |
California | Other | G57995 |
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