Basic Information
| Provider Information | |||||||||
| NPI: | 1871541714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POPE | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3700 PARK EAST DRIVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BEACHWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441224399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8552921401 | ||||||||
| FaxNumber: | 8663968340 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 RIVER STREET RIVER'S EDGE | ||||||||
| Address2: | UNIT 823 | ||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432598881 | ||||||||
| FaxNumber: | 8663968340 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 01/08/2016 | ||||||||
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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 | 2085R0202X | 18325 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 807444200 | 05 | ID | MEDICAID | P00329982 | 01 | SC | RXR MEDICARE | OTHER | 2650224 | 05 | OH | MEDICAID | 1016339230001 | 05 | PA | MEDICAID |