Individual
THOMAS LUPP II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4125 LONGVIEW AVE, ERIE, PA 16510-3535
(814) 860-0777
Mailing address
4125 LONGVIEW AVE, ERIE, PA 16510-3535
(814) 860-0777
Taxonomy
Speciality
Code
Description
License number
State
291900000X
Military Clinical Medical Laboratory
—
—
291U00000X
Clinical Medical Laboratory
Primary
1108070014
—
291U00000X
Clinical Medical Laboratory
44317
—
291U00000X
Clinical Medical Laboratory
4830
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1108070014
US DEPT OF HHS - CLINICAL LABORATORY TECHNOLOGIST
—
01
—
44317
ASCP MLT
—
01
—
4830
STATE OF HAWAII MLT
HI
Enumeration date
06/07/2014
Last updated
06/07/2014
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