Provider Demographics
NPI:1841446002
Name:ESTUPINAN BELTRAN, JUAN CARLOS (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:CARLOS
Last Name:ESTUPINAN BELTRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JUAN
Other - Middle Name:CARLOS
Other - Last Name:ESTUPINAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:ONE HOSPITAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06904-9317
Mailing Address - Country:US
Mailing Address - Phone:203-276-7298
Mailing Address - Fax:203-276-4842
Practice Address - Street 1:1 HOSPITAL PLZ
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-7298
Practice Address - Fax:203-276-4842
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46912207R00000X
CTPENDING208M00000X
OH35-125068208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH443340Medicare PIN