Healthcare Provider Details

I. General information

NPI: 1417377136
Provider Name (Legal Business Name): ANNA KUPCHA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: N/A N/A MD

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 BAY ST STE 206
TAUNTON MA
02780-1085
US

IV. Provider business mailing address

2005 BAY ST STE 206
TAUNTON MA
02780-1085
US

V. Phone/Fax

Practice location:
  • Phone: 508-823-7473
  • Fax:
Mailing address:
  • Phone: 508-823-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number57179
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number57179
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: