Provider Demographics
NPI:1871541714
Name:POPE, THOMAS L JR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:L
Last Name:POPE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3700 PARK EAST DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4399
Mailing Address - Country:US
Mailing Address - Phone:855-292-1401
Mailing Address - Fax:866-396-8340
Practice Address - Street 1:411 RIVER STREET RIVER'S EDGE
Practice Address - Street 2:UNIT 823
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-2662
Practice Address - Country:US
Practice Address - Phone:843-259-8881
Practice Address - Fax:866-396-8340
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-02-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2482452085R0202X
SC183252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807444200Medicaid
SCP00329982OtherRXR MEDICARE
PA1016339230001Medicaid
OH2650224Medicaid
SCD928958270Medicare PIN
ID807444200Medicaid
OH2650224Medicaid
SCP00329982OtherRXR MEDICARE