Provider Demographics
NPI:1881852630
Name:CUPP, DEBRA CLEMENT (RTR)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:CLEMENT
Last Name:CUPP
Suffix:
Gender:F
Credentials:RTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1463 STRIPERS COVE RD
Mailing Address - Street 2:
Mailing Address - City:GOODVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24095-3515
Mailing Address - Country:US
Mailing Address - Phone:540-296-0814
Mailing Address - Fax:
Practice Address - Street 1:1463 STRIPERS COVE RD
Practice Address - Street 2:
Practice Address - City:GOODVIEW
Practice Address - State:VA
Practice Address - Zip Code:24095-3515
Practice Address - Country:US
Practice Address - Phone:540-296-0814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA150305247100000X
FLCRT55220247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist