Provider Demographics
NPI:1285676353
Name:KUPIS, ROBERT JOHN (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:KUPIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 PARKWAY SOUTH
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385
Mailing Address - Country:US
Mailing Address - Phone:860-443-4383
Mailing Address - Fax:860-443-3980
Practice Address - Street 1:196 PARKWAY SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385
Practice Address - Country:US
Practice Address - Phone:860-443-4383
Practice Address - Fax:860-443-3980
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT893207RC0000X
CT000893363AM0700X
CA58266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
06-1616101OtherCOMMUNITY HEALTH NETWORK
P2626854OtherOXFORD/ECCD: 06-1616101
P2650601OtherOXFORD/ECCG: 06-1049086
06-1049086OtherCOMMUNITY HEALTH NETWORK
0V9727OtherHEALTHNET/ECCD:06-1616101
290001019CT03OtherANTHEM/ECCD:06-1616101
500HBC444CT01OtherANTHEM/HOSP-BASED ECCD
004210407OtherBLUECARE FAMILY PLAN
0V9726OtherHEALTHNET/ECCG:06-1049086
060064824OtherRR MED/ECCD: 06-1616101
290000893CT01OtherANTHEM/ECCG:06-1049086
641664OtherCONNECTICARE
970011351OtherRR MED/ECCG: 06-1049086
970000835Medicare ID - Type UnspecifiedECCD: 06-1616101
970000467Medicare ID - Type UnspecifiedECCG: 06-1049086
S93650Medicare UPIN