Individual
DR. GEORGETTA D. LUPOLD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
529 TERRY REILEY WAY, POTTSVILLE, PA 17901-1774
(570) 624-4444
(570) 624-4445
Mailing address
100 N ACADEMY AVE, CREDENTIALS DEPT, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD016590E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000687355
—
PA
Enumeration date
03/30/2006
Last updated
11/02/2011
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