Provider Demographics
NPI:1467470211
Name:KUPKOWSKI, DAVID G (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:KUPKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:565 ABBOTT RD
Mailing Address - Street 2:@ MERCY HOSPITAL OF BUFFALO
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14220-2039
Mailing Address - Country:US
Mailing Address - Phone:518-383-5450
Mailing Address - Fax:518-386-4223
Practice Address - Street 1:565 ABBOTT RD
Practice Address - Street 2:@ MERCY HOSPITAL OF BUFFALO
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14220-2039
Practice Address - Country:US
Practice Address - Phone:518-383-5450
Practice Address - Fax:518-383-4223
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY215786-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02273081Medicaid
NYRA1494Medicare ID - Type UnspecifiedINDV.MEDICARE #FOR GROUP
NYI06556Medicare UPIN