Provider Demographics
NPI:1932116878
Name:HUPP, JON A (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:A
Last Name:HUPP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8860 COLUMBIA 100 PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-2384
Mailing Address - Country:US
Mailing Address - Phone:410-964-8346
Mailing Address - Fax:410-964-8350
Practice Address - Street 1:888 BESTGATE RD STE 300
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2955
Practice Address - Country:US
Practice Address - Phone:410-964-8346
Practice Address - Fax:410-964-8350
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD59555208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402784100Medicaid
DC037082900Medicaid
DC409629Medicare PIN
MD066MMedicare PIN
MD066MF323Medicare PIN