Provider Demographics
NPI:1508940644
Name:KOUPAIE, JAFAR (MD)
Entity Type:Individual
Prefix:
First Name:JAFAR
Middle Name:
Last Name:KOUPAIE
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 1:95 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4006
Mailing Address - Country:US
Mailing Address - Phone:781-821-2888
Mailing Address - Fax:781-821-8684
Practice Address - Street 1:9889 MAGNOLIA AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3581
Practice Address - Country:US
Practice Address - Phone:951-566-5634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54177207NS0135X
CAC51581207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASX1138Medicare PIN
MAA57240OtherNEIGHBORHOOD HEALTH
MA6192041Medicaid
MA4069OtherHARVARD PILGRIM
MA705021OtherTUFTS HEALTH PLAN
MAJ04332OtherBCBS MA
MA03-00257OtherUNITED HEALTHCARE
MA32938OtherBMC HEALTHNET
MAA57240Medicare UPIN