MEDICARE: ELMER CUPINO MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	72629	MA
2	2084P0800X	Psychiatry Physician	MD046183L	PA
3	2084P0804X	Child & Adolescent Psychiatry Physician	72629	MA
4	2084P0804X	Child & Adolescent Psychiatry Physician	MD046183L	PA

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	02873900	OTHER		CAPITAL BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1376518977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELMER CUPINO MD

Provider Business Mailing Address
First Line	:	4 COUNTRY LN
Second Line	:
City	:	DOUGLASSVILLE
State	:	PA
Zip	:	19518-9627
Country	:	US
Telephone Number	:	570-617-1268
Fax Number	:	570-902-7736

Provider Business Practice Location Address
First Line	:	1695 MAIN ST FL 400
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01103-1063
Country	:	US
Telephone Number	:	413-241-3817
Fax Number	:	570-902-7736

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/03/2023

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039