Healthcare Provider Details

I. General information

NPI: 1346319969
Provider Name (Legal Business Name): GARY M. KUPFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW FL 1
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3800 RESERVOIR RD NW FL 1
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-7599
  • Fax: 202-444-3713
Mailing address:
  • Phone: 202-444-7599
  • Fax: 202-444-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101058469
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD048040
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: