Individual
JACOB EDWIN KUPERSTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3801 UNIVERSITY DR STE 300, FAIRFAX, VA 22030
(703) 383-8130
(703) 383-7355
Mailing address
3801 UNIVERSITY DR STE 300, FAIRFAX, VA 22030-2503
(703) 383-8130
(703) 383-7355
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
255486
MA
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
0101266254
VA
Other
Enumeration date
05/06/2012
Last updated
07/24/2019
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