Provider Demographics
NPI:1275663833
Name:RUPP, MICHAEL D (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:D
Last Name:RUPP
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:166 HANOVER ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-3549
Mailing Address - Country:US
Mailing Address - Phone:570-826-6875
Mailing Address - Fax:570-829-2280
Practice Address - Street 1:166 HANOVER ST
Practice Address - Street 2:SUITE 305
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3549
Practice Address - Country:US
Practice Address - Phone:570-826-6875
Practice Address - Fax:570-829-2280
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042006E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20771OtherGEISINGER HEALTH PLAN
PA2Y8502OtherHEALTH NET
PA0011586000005OtherMEDICAID
PA544571OtherFIRST PRIORITY LIFE INSUR
PA544571OtherHIGHMARK BLUE SHIELD
PA440442OtherFIRST PRIORITY HEALTH
PA544571OtherFIRST PRIORITY LIFE INSUR
PA544571OtherHIGHMARK BLUE SHIELD