Provider Demographics
NPI:1659076784
Name:DUPERREAULT, DAVID
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:DUPERREAULT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 SPRUCE ST # 5
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4201
Mailing Address - Country:US
Mailing Address - Phone:215-662-3719
Mailing Address - Fax:
Practice Address - Street 1:300 SPRUCE ST # 5
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19106-4201
Practice Address - Country:US
Practice Address - Phone:215-662-3719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program