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Individual

MICHAEL DAVID LUPA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2 PRINCESS RD STE E, LAWRENCE TOWNSHIP, NJ 08648-2320
(610) 303-5163
Mailing address
2 PRINCESS RD STE E, LAWRENCE TOWNSHIP, NJ 08648-2320
(610) 303-5163

Taxonomy

Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
25MA09847400
NJ
207Y00000X
Otolaryngology Physician
MD457006
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
510172ZVKU
MEMBER PTAN
NJ
Enumeration date
01/08/2008
Last updated
01/16/2020
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