Provider Demographics
NPI:1801914981
Name:SHUPING, LEE THOMAS (MD, MPT)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:THOMAS
Last Name:SHUPING
Suffix:
Gender:M
Credentials:MD, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 FORDHAM BLVD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2200
Mailing Address - Country:US
Mailing Address - Phone:984-974-9747
Mailing Address - Fax:984-974-9786
Practice Address - Street 1:1807 FORDHAM BLVD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2200
Practice Address - Country:US
Practice Address - Phone:984-974-9747
Practice Address - Fax:984-974-9786
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2017-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116023402208100000X, 208100000X
NC10443225100000X
NC2015-00533208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC067X8OtherBLUE CROSS
NC7212079Medicaid