Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 010221321 | VA |
N | 111NI0900X | Internist | 010221321 | VA |
N | 207RG0300X | Geriatric Medicine | 0102201321 | VA |
NPI | 1104898691 |
---|---|
Provider Name | Dr. Paul Chupka |
First Address | Virginia Beach, VA 23450-2546 |
Second Address | Virginia Beach, VA 23454-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 09/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005881757 | (05) | VA |
H75149 | (02) |