Healthcare Provider Details

I. General information

NPI: 1700383999
Provider Name (Legal Business Name): RAJESH KUPPURAJU
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 OSTRUM ST STE 2
BETHLEHEM PA
18015-1000
US

IV. Provider business mailing address

801 OSTRUM ST STE 2
BETHLEHEM PA
18015-1000
US

V. Phone/Fax

Practice location:
  • Phone: 484-503-0055
  • Fax: 833-822-5226
Mailing address:
  • Phone: 484-503-0055
  • Fax: 833-822-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberOS023153
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: