Provider Demographics
NPI:1528025319
Name:LUPO, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LUPO
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 1:3050 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7101
Mailing Address - Country:US
Mailing Address - Phone:941-342-9750
Mailing Address - Fax:941-342-9788
Practice Address - Street 1:3050 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7101
Practice Address - Country:US
Practice Address - Phone:941-342-9750
Practice Address - Fax:941-342-9788
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77141207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202343146OtherTAX ID
FLK7656Medicare ID - Type Unspecified
FL202343146OtherTAX ID