Provider Demographics
NPI:1033137559
Name:LUPTAKOVA, KATARINA (MD)
Entity Type:Individual
Prefix:
First Name:KATARINA
Middle Name:
Last Name:LUPTAKOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LAKE SHORE RD
Mailing Address - Street 2:#3
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-6347
Mailing Address - Country:US
Mailing Address - Phone:617-789-3000
Mailing Address - Fax:
Practice Address - Street 1:CARITAS ST. ELIZABETH'S MEDICAL CENTER
Practice Address - Street 2:736 CAMBRIDGE STREET
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-789-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA228519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine