Provider Demographics
NPI:1942438999
Name:DUPRE, CALLUM MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:CALLUM
Middle Name:MICHAEL
Last Name:DUPRE
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 1:1401 WHITEHORSE MERCERVILLE RD STE 219
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-3835
Mailing Address - Country:US
Mailing Address - Phone:609-584-5150
Mailing Address - Fax:609-584-5144
Practice Address - Street 1:1401 WHITEHORSE MERCERVILLE RD
Practice Address - Street 2:SUITE 219
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08619-3835
Practice Address - Country:US
Practice Address - Phone:609-584-5150
Practice Address - Fax:609-587-5144
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB094938002084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ361991 YEZJMedicare PIN
MNCO0000012Medicare PIN