Provider Demographics
NPI:1376518977
Name:CUPINO, ELMER (MD)
Entity Type:Individual
Prefix:
First Name:ELMER
Middle Name:
Last Name:CUPINO
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 1:4 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-9627
Mailing Address - Country:US
Mailing Address - Phone:570-617-1268
Mailing Address - Fax:570-902-7736
Practice Address - Street 1:1695 MAIN ST FL 400
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-1063
Practice Address - Country:US
Practice Address - Phone:413-241-3817
Practice Address - Fax:570-902-7736
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA726292084P0800X, 2084P0804X
PAMD046183L2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
02873900OtherCAPITAL BLUE CROSS
PA0012780540003Medicaid
02873900OtherCAPITAL BLUE CROSS