Provider Demographics
NPI:1659363984
Name:KUPREVICH, WILLIAM J JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:J
Last Name:KUPREVICH
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:6850 LOWS RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8729
Mailing Address - Country:US
Mailing Address - Phone:570-784-7300
Mailing Address - Fax:570-784-7331
Practice Address - Street 1:6850 LOWS RD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8729
Practice Address - Country:US
Practice Address - Phone:570-784-7300
Practice Address - Fax:570-784-7331
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2007-09-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS003207L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006488940005Medicaid
B36452Medicare UPIN
PA0006488940005Medicaid