Provider Demographics
NPI:1073503348
Name:HAUPERT, GARNER TRIPP JR (MD)
Entity Type:Individual
Prefix:DR
First Name:GARNER
Middle Name:TRIPP
Last Name:HAUPERT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:GRB 1003 RENAL ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-5050
Practice Address - Fax:617-724-1122
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA39854207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA039854OtherTUFTS HEALTH PLAN
MAM09971OtherBCBS MA
MA2074516Medicaid
MAM09971Medicare ID - Type Unspecified
MA2074516Medicaid