Provider Demographics
NPI:1558366351
Name:SKORUPKA, MIROSLAWA (MD)
Entity Type:Individual
Prefix:
First Name:MIROSLAWA
Middle Name:
Last Name:SKORUPKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:500 MERRIMACK ST
Mailing Address - Street 2:RIVERWALK
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01843-1756
Mailing Address - Country:US
Mailing Address - Phone:978-557-8700
Mailing Address - Fax:978-557-8856
Practice Address - Street 1:500 MERRIMACK ST
Practice Address - Street 2:RIVERWALK
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01843-1756
Practice Address - Country:US
Practice Address - Phone:978-557-8700
Practice Address - Fax:978-557-8856
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2012-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA74596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110214692OtherRAILROAD MEDICARE
0016303OtherNEIGHBORHOOD HEALTH PLAN
0349762OtherCIGNA HEALTHCARE
NHE73376OtherANTHEM BLUE CROSS
04-05306OtherEVERCARE
MA110049946AOtherMASSHEALTH
MA1558366351OtherFALLON COMMUNITY HEALTH PLAN
MA3078582Medicaid
MA62888OtherHARVARD PILGRIM HEALTHCAR
MDJ11139OtherBLUE CROSS BLUE SHIELD
63410OtherHEALTHSOURCE
MA719822OtherTUFTS HEALTH PLAN
974951OtherNETWORK HEALTH
NH30010844OtherNH MEDICAID
04-05306OtherEVERCARE
0349762OtherCIGNA HEALTHCARE