Provider Demographics
NPI:1992191266
Name:LAPUCHA, MATEUSZ ANDRZEJ (MD)
Entity Type:Individual
Prefix:
First Name:MATEUSZ
Middle Name:ANDRZEJ
Last Name:LAPUCHA
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 1:2 HOPKINS PLZ UNIT 1613
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-2943
Mailing Address - Country:US
Mailing Address - Phone:337-371-8163
Mailing Address - Fax:
Practice Address - Street 1:222 N PACIFIC COAST HWY STE 1420
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-5648
Practice Address - Country:US
Practice Address - Phone:877-878-3289
Practice Address - Fax:877-817-3227
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV19688208D00000X
LA321700208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA321700OtherLOUISIANA STATE BOARD OF MEDICAL EXAMINERS
NV19688OtherNEVADA STATE BOARD OF MEDICAL EXAMINERS