Basic Information
| Provider Information | |||||||||
| NPI: | 1265694194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPA | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | ALLAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5105 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049155100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192205255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2196 NC HWY 42 W | ||||||||
| Address2: | |||||||||
| City: | CLAYTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275208343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197631050 | ||||||||
| FaxNumber: | 9197631055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2008 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 35.121857 | OH | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 4301092915 | MI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | 2014-01150 | NC | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2014-01150 | 01 | NC | MEDICAL LICENSE | OTHER | 0088367 | 05 | OH | MEDICAID | 35.121857 | 01 | OH | LICENSE | OTHER |