Provider Demographics
NPI:1013990019
Name:LUPTON, FREDERICK ARTHUR III (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:ARTHUR
Last Name:LUPTON
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 14994
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4994
Mailing Address - Country:US
Mailing Address - Phone:336-271-2777
Mailing Address - Fax:336-273-1910
Practice Address - Street 1:1587 YANCEYVILLE ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27405-6933
Practice Address - Country:US
Practice Address - Phone:336-271-2777
Practice Address - Fax:336-273-1910
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33706207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8953282Medicaid
53282OtherBCBS
NC070015164OtherMEDICARE RAILROAD
562221469OtherUHC/CIGNA/FIRST HEALTH
NC070015164OtherMEDICARE RAILROAD
562221469OtherUHC/CIGNA/FIRST HEALTH