Healthcare Provider Details

I. General information

NPI: 1376518977
Provider Name (Legal Business Name): ELMER CUPINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 MAIN ST FL 400
SPRINGFIELD MA
01103-1063
US

IV. Provider business mailing address

4 COUNTRY LN
DOUGLASSVILLE PA
19518-9627
US

V. Phone/Fax

Practice location:
  • Phone: 413-241-3817
  • Fax: 570-902-7736
Mailing address:
  • Phone: 570-617-1268
  • Fax: 570-902-7736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number72629
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD046183L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number72629
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD046183L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: