Basic Information
| Provider Information | |||||||||
| NPI: | 1538196449 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POPE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | HENRY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 681 HIOAKS RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045600490 | ||||||||
| FaxNumber: | 8045603424 | ||||||||
| Practice Location | |||||||||
| Address1: | 681 HIOAKS RD | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045600490 | ||||||||
| FaxNumber: | 8045603424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 08/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0101027856 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 229892 | 01 | SO HEALTH | OTHER | 1538196449 | 05 | VA | MEDICAID | 269684 | 01 | ANTHEM | OTHER | 5699100 | 05 | VA | MEDICAID |