Provider Demographics
NPI:1982644464
Name:MARK A. LUPO,M.D.,P.A.
Entity Type:Organization
Organization Name:MARK A. LUPO,M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LUPO
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACE
Authorized Official - Phone:941-342-9750
Mailing Address - Street 1:3050 BEE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-7101
Mailing Address - Country:US
Mailing Address - Phone:941-342-9750
Mailing Address - Fax:
Practice Address - Street 1:3050 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-7101
Practice Address - Country:US
Practice Address - Phone:941-342-9750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77141207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK7656Medicare ID - Type UnspecifiedGROUP NUMBER