Provider Demographics
NPI:1477515369
Name:LUPIA, RAUL H (MD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:H
Last Name:LUPIA
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 1:8801 BLUFF POINTE CT
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-4133
Mailing Address - Country:US
Mailing Address - Phone:919-676-9819
Mailing Address - Fax:
Practice Address - Street 1:720 MALCOLM BLVD
Practice Address - Street 2:
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690
Practice Address - Country:US
Practice Address - Phone:843-237-3378
Practice Address - Fax:843-237-5073
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400906207P00000X
IN01042330A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100387590Medicaid
SCN00907Medicaid
NC13091OtherBCBS
IN000000518336OtherBCBS
NC8913091Medicaid
IN000000518336OtherBCBS
SCAA48359326Medicare PIN
IN131180AAAMedicare PIN
NC8913091Medicaid
SCN00907Medicaid