Provider Demographics
NPI:1952780256
Name:PUPILLO, STEPHEN DOMINIC (DO)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:DOMINIC
Last Name:PUPILLO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 COVINGTON ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1617
Mailing Address - Country:US
Mailing Address - Phone:330-480-2616
Mailing Address - Fax:330-480-7979
Practice Address - Street 1:1001 COVINGTON ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510
Practice Address - Country:US
Practice Address - Phone:330-480-2616
Practice Address - Fax:330-480-7979
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.013255207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine