Provider Demographics
NPI:1598352817
Name:DANIELA J SCHUPP MD PHD, PLLC
Entity Type:Organization
Organization Name:DANIELA J SCHUPP MD PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHUPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD PHD
Authorized Official - Phone:970-210-0357
Mailing Address - Street 1:PO BOX 29936
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2051
Mailing Address - Country:US
Mailing Address - Phone:970-986-4418
Mailing Address - Fax:833-382-1178
Practice Address - Street 1:525 NORTH AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-7512
Practice Address - Country:US
Practice Address - Phone:970-986-4418
Practice Address - Fax:833-382-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty