Individual
MR. CLARENCE A STUPPARD SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ADMINISTRATOR
Contact information
Practice address
2924 BRIGHTON ST, PHILADELPHIA, PA 19149-1922
(215) 624-1321
(215) 624-1034
Mailing address
2924 BRIGHTON ST, PHILADELPHIA, PA 19149-1922
(215) 624-1321
(215) 624-1034
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
16713601
PA
251E00000X
Home Health Agency
Primary
16713601
PA
Other
Enumeration date
09/30/2010
Last updated
09/30/2010
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