Provider Demographics
NPI:1922123629
Name:SCHUPPERT, JAMES LEO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEO
Last Name:SCHUPPERT
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 1:88 TIOGA AVE
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14831-0001
Mailing Address - Country:US
Mailing Address - Phone:607-974-4870
Mailing Address - Fax:607-974-4819
Practice Address - Street 1:88 TIOGA AVE
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14831-0001
Practice Address - Country:US
Practice Address - Phone:607-974-4870
Practice Address - Fax:607-974-4819
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY177460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine