Provider Demographics
NPI:1184615619
Name:RUPP, JOSEPH JOHN (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:JOHN
Last Name:RUPP
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MEMORIAL DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7057
Mailing Address - Country:US
Mailing Address - Phone:814-623-6191
Mailing Address - Fax:814-623-5519
Practice Address - Street 1:202 MEMORIAL DR
Practice Address - Street 2:SUITE 3
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7057
Practice Address - Country:US
Practice Address - Phone:814-623-6191
Practice Address - Fax:814-623-5519
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001799L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005065850008Medicaid
PA042860Medicare ID - Type Unspecified
PA0005065850008Medicaid
PAT27311Medicare UPIN