Provider Demographics
NPI:1164502894
Name:STUPPY, PAMELA B (RD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:B
Last Name:STUPPY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 251
Mailing Address - Street 2:
Mailing Address - City:YORK HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:03911
Mailing Address - Country:US
Mailing Address - Phone:207-363-8392
Mailing Address - Fax:207-363-8392
Practice Address - Street 1:1 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-2904
Practice Address - Country:US
Practice Address - Phone:207-363-8392
Practice Address - Fax:207-363-8392
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MED1610133V00000X
NH23133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0022500Medicare PIN
NH002250001Medicare PIN