Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC003388L | PA |
Y | 222Z00000X | Podiatrist | SC003388L | PA |
NPI | 1013999234 |
---|---|
Provider Name | Dr. George John Kupar |
First Address | Washington, PA 15301-3238 |
Second Address | Washington, PA 15301-3238 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 22/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T93002 | (02) | PA |