Provider Demographics
NPI:1457310419
Name:TUPPER, DONALD ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ALLEN
Last Name:TUPPER
Suffix:
Gender:M
Credentials:DPM
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 728
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-0728
Mailing Address - Country:US
Mailing Address - Phone:740-622-8400
Mailing Address - Fax:740-622-8437
Practice Address - Street 1:1529 WALNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-2250
Practice Address - Country:US
Practice Address - Phone:740-622-8400
Practice Address - Fax:740-622-8437
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002145213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00260813OtherRAILROAD MEDICARE
OH557035Medicaid
OH31-1118753OtherFEDERAL TAX ID
OH000000118491OtherANTHEM / BLUE CROSS
OH557035Medicaid
T80780Medicare UPIN