Provider Demographics
NPI:1700854130
Name:TUPPER, ROBERT D (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:TUPPER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:D
Other - Last Name:TUPPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:4224 HOLLAND RD
Mailing Address - Street 2:SUITE # 106
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1900
Mailing Address - Country:US
Mailing Address - Phone:757-498-0202
Mailing Address - Fax:757-498-7936
Practice Address - Street 1:4224 HOLLAND RD
Practice Address - Street 2:SUITE # 106
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1900
Practice Address - Country:US
Practice Address - Phone:757-498-0202
Practice Address - Fax:757-498-7936
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000799213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA052696OtherANTHEM BLUE CROSS BLUE SH
VA9300350Medicaid
VA312180OtherMDIPA
VA5180770002OtherDMERC
VA15432OtherOPTIMA HEALTH
VA5180770001OtherDMERC
VA15432OtherOPTIMA HEALTH