Healthcare Provider Details

I. General information

NPI: 1205087616
Provider Name (Legal Business Name): DAVID YUPPA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2008
Last Update Date: 06/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 BROOKLINE AVE DANA 2083
BOSTON MA
02215-5418
US

IV. Provider business mailing address

450 BROOKLINE AVE
BOSTON MA
02215-5418
US

V. Phone/Fax

Practice location:
  • Phone: 617-632-6181
  • Fax: 617-632-6180
Mailing address:
  • Phone: 617-632-6181
  • Fax: 617-632-6180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number253256
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number253256
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: