Provider Demographics
NPI:1851092589
Name:CHUPP, JUSTIN (CSFA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:CHUPP
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10836 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:DE
Mailing Address - Zip Code:19960-3730
Mailing Address - Country:US
Mailing Address - Phone:302-841-9552
Mailing Address - Fax:
Practice Address - Street 1:10836 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:DE
Practice Address - Zip Code:19960-3730
Practice Address - Country:US
Practice Address - Phone:302-841-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE172528246ZC0007X
172528246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant