Provider Demographics
NPI:1528021391
Name:ZUPRUK, GERALD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MICHAEL
Last Name:ZUPRUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1219 LEXINGTON AVE STE B
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-2784
Practice Address - Country:US
Practice Address - Phone:336-481-8590
Practice Address - Fax:336-481-5899
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149214207T00000X
NC2016-00014207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA68237Medicare UPIN
NYRB1731Medicare PIN