Individual
DR. MICHAEL D RUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., F.A.C.C.
Contact information
Practice address
166 HANOVER ST, SUITE 305, WILKES BARRE, PA 18702-3549
(570) 826-6875
(570) 829-2280
Mailing address
166 HANOVER ST, SUITE 305, WILKES BARRE, PA 18702-3549
(570) 826-6875
(570) 829-2280
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
MD042006E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0011586000005
MEDICAID
PA
01
—
20771
GEISINGER HEALTH PLAN
PA
01
—
2Y8502
HEALTH NET
PA
01
—
440442
FIRST PRIORITY HEALTH
PA
01
—
544571
FIRST PRIORITY LIFE INSUR
PA
Enumeration date
03/06/2007
Last updated
03/31/2008
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