Healthcare Provider Details

I. General information

NPI: 1649261645
Provider Name (Legal Business Name): ERIC M TUPIS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 DURALEIGH RD STE 100
RALEIGH NC
27612-8105
US

IV. Provider business mailing address

120 WILLIAM PENN PLZ
DURHAM NC
27704-2150
US

V. Phone/Fax

Practice location:
  • Phone: 919-788-8797
  • Fax: 919-313-1276
Mailing address:
  • Phone: 919-220-5255
  • Fax: 919-313-1276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberCOOO2786
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06022
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9108044
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: