Provider Demographics
NPI:1932197852
Name:STUPAK, HOWARD DAVID (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:DAVID
Last Name:STUPAK
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 1:163 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-3307
Mailing Address - Country:US
Mailing Address - Phone:203-227-1826
Mailing Address - Fax:203-227-3756
Practice Address - Street 1:163 MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-3307
Practice Address - Country:US
Practice Address - Phone:203-227-1826
Practice Address - Fax:203-227-3756
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT043483207Y00000X
NY236302207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
L3924Medicare UPIN