Provider Demographics
NPI:1093707382
Name:SCHUPBACH, CURTIS WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:WAYNE
Last Name:SCHUPBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-4314
Mailing Address - Country:US
Mailing Address - Phone:704-358-9900
Mailing Address - Fax:704-344-0105
Practice Address - Street 1:2620 E 7TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-4314
Practice Address - Country:US
Practice Address - Phone:704-358-9900
Practice Address - Fax:704-344-0105
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19542207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C89473Medicare UPIN
210241BMedicare ID - Type Unspecified