Healthcare Provider Details

I. General information

NPI: 1922055177
Provider Name (Legal Business Name): PAUL KUPCHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 LIMESTONE RD SUITE 101
WILMINGTON DE
19808
US

IV. Provider business mailing address

1941 LIMESTONE RD SUITE 101
WILMINGTON DE
19808
US

V. Phone/Fax

Practice location:
  • Phone: 302-633-3555
  • Fax: 302-633-3559
Mailing address:
  • Phone: 302-633-3555
  • Fax: 302-633-3559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License NumberC10004562
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberC10004562
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: