Provider Demographics
NPI:1114913233
Name:PUPI, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:PUPI
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 1:93 BOUNDRY LN
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2949
Mailing Address - Country:US
Mailing Address - Phone:724-728-8300
Mailing Address - Fax:724-728-6470
Practice Address - Street 1:93 BOUNDRY LN
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2949
Practice Address - Country:US
Practice Address - Phone:724-728-8300
Practice Address - Fax:724-728-6470
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD009488E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA006392220001Medicaid
PAB32993Medicare UPIN
PA006392220001Medicaid