Provider Demographics
NPI:1093752685
Name:PUPO, RAFAEL A (MD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:PUPO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:228 BILLERICA RD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-3604
Mailing Address - Country:US
Mailing Address - Phone:978-250-6010
Mailing Address - Fax:978-244-6610
Practice Address - Street 1:228 BILLERICA RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3604
Practice Address - Country:US
Practice Address - Phone:978-250-6010
Practice Address - Fax:978-244-6610
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA70601207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3186750Medicaid
MA3186750Medicaid