Provider Demographics
NPI:1568596641
Name:SWARUP, RUPENDRA (MD)
Entity Type:Individual
Prefix:
First Name:RUPENDRA
Middle Name:
Last Name:SWARUP
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 1:33-57 HARRISON STREET
Mailing Address - Street 2:UHS WILSON MEDICAL CENTER
Mailing Address - City:JOHNSON
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2107
Mailing Address - Country:US
Mailing Address - Phone:607-763-6000
Mailing Address - Fax:
Practice Address - Street 1:33-57 HARRISON STREET
Practice Address - Street 2:UHS WILSON MEDICAL CENTER
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2107
Practice Address - Country:US
Practice Address - Phone:607-763-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0703352084N0400X
NC2021-014342084N0400X
NY199795-12084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG63500Medicare UPIN