Healthcare Provider Details

I. General information

NPI: 1235350711
Provider Name (Legal Business Name): JOSEPH FERLITA LUPO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W. DR. MARTIN LUTHER KING JR. BLVD. SUITE C
TAMPA FL
33603
US

IV. Provider business mailing address

720 W. DR. MARTIN LUTHER KING JR. BLVD. SUITE C
TAMPA FL
33603
US

V. Phone/Fax

Practice location:
  • Phone: 813-276-1411
  • Fax: 813-223-7854
Mailing address:
  • Phone: 813-276-1411
  • Fax: 813-223-7854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME11239
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: