Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RA0201X | Internist - Allergy & Immunology | MD14192 | DC |
Y | 207RR0500X | Rheumatology | MD14192 | DC |
NPI | 1336147206 |
---|---|
Provider Name | Thomas Cupps |
First Address | Boston, MA 02241-8283 |
Second Address | Washington, DC 20007-2113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 05/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B95005 | (02) | |
P00894792 | RAILROAD MEDICARE (01) | DC |