Healthcare Provider Details

I. General information

NPI: 1760909121
Provider Name (Legal Business Name): JOSHUA ADAM HUPPERT AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2017
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 STRAWBERRY AVE
LEWISTON ME
04240-5941
US

IV. Provider business mailing address

15 STRAWBERRY AVE
LEWISTON ME
04240-5941
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-7740
  • Fax: 207-777-7748
Mailing address:
  • Phone: 207-777-7740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAP4140
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: