Provider Demographics
NPI:1578517660
Name:RAYMOND R. LUPKAS JR, M.D. P.A.
Entity Type:Organization
Organization Name:RAYMOND R. LUPKAS JR, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUPKAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:410-819-0710
Mailing Address - Street 1:PO BOX 890178
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0178
Mailing Address - Country:US
Mailing Address - Phone:410-819-0710
Mailing Address - Fax:410-819-0712
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-715-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9401442207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC050041120OtherRR MEDICARE
NC8953257Medicaid
NC040644894OtherTRICARE
SCN60874Medicaid
NC2207168Medicare PIN
SCN60874Medicaid
NCF22236Medicare UPIN
SCN60874Medicaid