Provider Demographics
NPI:1477742005
Name:KUPAS, DANIEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:KUPAS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:APOLLO
Mailing Address - State:PA
Mailing Address - Zip Code:15613-1150
Mailing Address - Country:US
Mailing Address - Phone:724-478-2999
Mailing Address - Fax:724-478-3005
Practice Address - Street 1:310 S 2ND ST
Practice Address - Street 2:
Practice Address - City:APOLLO
Practice Address - State:PA
Practice Address - Zip Code:15613-1150
Practice Address - Country:US
Practice Address - Phone:724-478-2999
Practice Address - Fax:724-478-3005
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-008135L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG12853OtherUPIN