Provider Demographics
NPI:1942361928
Name:RUPEKA, JASON A (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:RUPEKA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6106
Mailing Address - Country:US
Mailing Address - Phone:330-392-5800
Mailing Address - Fax:330-259-7792
Practice Address - Street 1:2218 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6106
Practice Address - Country:US
Practice Address - Phone:330-392-5800
Practice Address - Fax:330-259-7792
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-008796207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2704943Medicaid
OH2704943Medicaid