Provider Demographics
NPI:1932148160
Name:SHUPERT, JOHN H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:H
Last Name:SHUPERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 27TH ST
Mailing Address - Street 2:WALLER BUILDING, SUITE B06
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-2677
Mailing Address - Country:US
Mailing Address - Phone:740-356-8008
Mailing Address - Fax:740-353-7900
Practice Address - Street 1:126 N CROSS ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1209
Practice Address - Country:US
Practice Address - Phone:937-544-8989
Practice Address - Fax:937-544-5659
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-083116207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2426333Medicaid
OHP00157248OtherRAILROAD MEDICARE
KY64071848Medicaid
OHP00157248OtherRAILROAD MEDICARE
OHH74405Medicare UPIN
OH2426333Medicaid