Provider Demographics
NPI:1790775542
Name:PUOPOLO, ANTHONY DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DAVID
Last Name:PUOPOLO
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 1:5 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-4105
Mailing Address - Country:US
Mailing Address - Phone:508-473-5500
Mailing Address - Fax:508-478-6247
Practice Address - Street 1:5 WATER ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-4105
Practice Address - Country:US
Practice Address - Phone:508-473-5500
Practice Address - Fax:508-478-6247
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32956208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA032956OtherTUFTS
MA9714243Medicaid
MAM12700OtherBLUE CROSS
MA34393OtherH.C.H.P
MA17661OtherCIGNA
MA758598OtherTUFTS
MA2002418Medicaid
MA2002418Medicaid
MAM12700OtherBLUE CROSS