Provider Demographics
NPI:1659479830
Name:KUPFERMAN, SUSAN PAULETTE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:PAULETTE
Last Name:KUPFERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 116TH AVE NE
Mailing Address - Street 2:SUITE #104
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3014
Mailing Address - Country:US
Mailing Address - Phone:425-454-0345
Mailing Address - Fax:
Practice Address - Street 1:1600 116TH AVE NE
Practice Address - Street 2:SUITE #104
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3014
Practice Address - Country:US
Practice Address - Phone:425-454-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040018208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAH41470Medicare UPIN
WAG8800277Medicare PIN