Provider Demographics
NPI:1407448442
Name:CHUPP, ELIZABETH MARY
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARY
Last Name:CHUPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 WALTON AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-5037
Mailing Address - Country:US
Mailing Address - Phone:216-417-8375
Mailing Address - Fax:
Practice Address - Street 1:2710 WALTON AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-5037
Practice Address - Country:US
Practice Address - Phone:216-417-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty