Provider Demographics
NPI:1790771996
Name:RUPARELIA, ASHUTOSH H (MD)
Entity Type:Individual
Prefix:
First Name:ASHUTOSH
Middle Name:H
Last Name:RUPARELIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ASCOT PLACE
Mailing Address - Street 2:
Mailing Address - City:ITHICA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1072
Mailing Address - Country:US
Mailing Address - Phone:607-266-0772
Mailing Address - Fax:607-266-0176
Practice Address - Street 1:2 ASCOT PLACE
Practice Address - Street 2:
Practice Address - City:ITHICA
Practice Address - State:NY
Practice Address - Zip Code:14850-1072
Practice Address - Country:US
Practice Address - Phone:607-266-0772
Practice Address - Fax:607-266-0176
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2044981207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01688251Medicaid
34747GMedicare ID - Type Unspecified
NY01688251Medicaid