Provider Demographics
NPI:1477572816
Name:KUPERMAN-BEADE, MARINA (MD, FAAD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:KUPERMAN-BEADE
Suffix:
Gender:F
Credentials:MD, FAAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RANDALL SQUARE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2709
Mailing Address - Country:US
Mailing Address - Phone:401-751-7546
Mailing Address - Fax:
Practice Address - Street 1:1030 PRESIDENT AVE STE 306
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-5923
Practice Address - Country:US
Practice Address - Phone:401-751-7546
Practice Address - Fax:401-751-6888
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10753207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIP00241153OtherRAILROAD MEDICARE
RI9023992Medicaid
RI007056892Medicare PIN
RI9023992Medicaid