Provider Demographics
NPI:1497978837
Name:DUPUY, SAMUEL STUART JR (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:STUART
Last Name:DUPUY
Suffix:JR
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 1:9735 KINCEY AVENUE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9118
Mailing Address - Country:US
Mailing Address - Phone:704-414-2870
Mailing Address - Fax:704-414-2860
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PARKWAY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-846-0809
Practice Address - Fax:704-283-4705
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18092208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8929532Medicaid
NC8929532Medicaid
NC201430DMedicare ID - Type UnspecifiedNC MEDICARE